STEMI Mortality Reduced With Admission to Primary PCI Center
Direct admission correlated with a 44-minute shorter median symptoms-to-admission time.
HealthDay News – For patients with ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI), direct admission to a primary PCI center is associated with lower 12-month mortality, according to a study published online in JACC: Cardiovascular Interventions.
Using data from a prospective nationwide registry, Damian Kawecki, MD, PhD, from the Medical University of Silesia in Poland, and colleagues examined the impact of direct admission vs transfer via regional hospital to a PCI center on time delays and 12-month mortality in STEMI patients. A total of 70,093 patients were eligible for analysis, of whom 56% were admitted directly to a PCI center.
The researchers found that direct admission correlated with a 44-minute shorter median symptoms-to-admission time (P <.001) and total ischemic time (228 vs 270 minutes; P <.001), higher left ventricle ejection fraction (47.5% vs 46.3%; P <.001), and lower propensity-matched 12-month mortality (9.6% vs 10.4%; P <.001). Direct admissions and shorter symptoms-to-admission time were significant predictors of lower 12-month mortality in propensity matched analysis (hazard ratios, 1.06 and 1.03, respectively).
"In a large, community-based cohort of patients with STEMI treated by PCI, direct admission to a primary PCI center was associated with lower 12-month mortality and should be preferred to transfer via a regional non-PCI-capable facility," the authors wrote.
Kawecki D, Gierlotka M, Morawiec B, et al. Direct admission vs interhospital transfer for primary percutaneous coronary intervention in ST-segment elevation myocardial infarction [published online February 15, 2017]. JACC Cardiovasc Interv. doi:10.1016/j.jcin.2016.11.028
Berger PB, Perini M, Becker LB. STEMI care in Poland and the United States. Both have some distance yet to travel [February 15, 2017]. JACC Cardiovasc Interv. doi:10:1016/j.jcin.2017.01.006