AHA: Bypassing Non-PCI Hospital Ups Outcomes in STEMI
(HealthDay News) – Patients with ST-segment elevation myocardial infarction (STEMI) who are taken directly to a percutaneous coronary intervention (PCI)-capable hospital, even if they have to bypass a closer non-PCI hospital, receive treatment significantly faster than patients who need to be transferred for treatment.
Emil L. Fosbol, MD, PhD, from Duke University in Durham, NC, and colleagues selected 1,224 emergency medical service (EMS)-transported patients with STEMI who either bypassed a closer non-PCI hospital to go directly to a PCI center or were first taken to a non-PCI center and subsequently transferred for PCI.
The researchers found that 63% of patients bypassed a non-PCI center, while 37% were first treated at a non-PCI hospital and then transferred for PCI. In adjusted analyses, undergoing bypass was predicted by being of white race (odds ratio [OR], 1.37), having chest pain as the chief complaint (OR, 2.08), having received a pre-hospital 12-lead electrocardiogram (OR, 2.14), cardiogenic shock (OR, 1.82), and a prior history of PCI (OR, 1.66). Time from first-medical-contact to PCI was significantly shorter in the bypass group (95 minutes, vs. 179 minutes in the non-bypass group). Compared with the non-bypass group, crude in-hospital mortality was lower in the bypass group (6.3 vs. 9.4%; P=0.046).
"PCI is contingent on getting the patient very quickly to a hospital with a catheter lab," Fosbol said in a statement. "Our results suggest that when logistically feasible, EMS should transfer STEMI patients directly to the nearest PCI-capable hospital."