A Transfer for PCI versus Conservative Treatment at a Late Electrocardiographic Stage of Myocardial Infarction on Admission: Long-Term Outcomes

Abstract

Background: Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy in acute STelevation myocardial infarction (MI), but is unclear what electrocardiographic (ECG) signs on admission show that it is too late to transfer the patients to a PCI-capable hospital. Therefore, we performed this exploratory study. Methods: A prospective cohort study enrolling 42 patients with the chosen signs of a late ECG stage of MI on admission was performed. Long-term outcomes were compared in 15 patients treated conservatively and 12 patients transferred to a PCI-capable hospital who underwent PCI. The new ischemic events, deaths, changes in the ECG QRS score, echocardiographic ejection fraction, and index of impaired myocardial contraction were assessed after 1.5 years. Results: No significant differences were found in the groups, except for impaired myocardial contraction, which improved in the PCI group (a score of 1.83 ± 0.98 vs. 0.78 ± 0.44, P = 0.04), but this group was significantly younger (65.3 ± 13.86 vs. 80.1 ± 6.17, P = 0.006). Conclusions: There were no clear advantages of the transfer for PCI over conservative treatment at this ECG stage of MI on admission, except the improvement of impaired myocardial contraction. That is a hypothesis for later confirmation in larger age standardized studies, because in our study many patients were lost due to specific patients arriving to a non-PCI-capable hospital and the patients transferred for PCI were significantly younger. We hope this study will help plan further researches.