Abstract 10840: Direct Admission versus Inter-Hospital Transfer of Hospitalized Patients with Acute Myocardial Infarction in China: Findings from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome Project

Abstract

Introduction: Although percutaneous coronary intervention (PCI) is the preferred reperfusion strategy for AMI, a substantial proportion of patients initially arrive at non-PCI hospitals. The impact of direct admission to a PCI-capable hospital and inter-hospital transfer on prognosis of AMI with relatively long ischemia time in real-world practice is still debated. We aimed to compare the in-hospital outcomes associated with direct admission versus inter-hospital transfer of hospitalized patients with AMI in China. Methods: From November 2014 to December 2019, 94,623 patients with AMI were enrolled from 159 tertiary hospitals and 82 secondary hospitals in 30 provinces in China in the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) Project. Patients were divided into those directly admitted or inter-hospital transferred to a PCI hospital. Associations of direct admission versus inter-hospital transfer with in-hospital major adverse cardiovascular events (MACE) were examined by multivariable Cox regression, propensity score matching (PSM), and inverse probability of treatment weighting (IPTW) analysis. Results: Among the 94,623 patients, 53,653 (56.7%) were directly admitted to PCI hospitals, and 40,970 (43.3%) were inter-hospital transferred. Compared with inter-hospital transfer, direct admission was associated with a shorter time from symptom onset to reperfusion (6.0h vs.9.8h for STEMI and 54.4h vs.83.3h for NSTEMI), and higher rates of reperfusion for STEMI (63.4% vs. 50.7%) and timely PCI for NSTEMI (41.1% vs. 34.7%). No significant associations were found between direct admission relative to inter-hospital transfer and the risk of in-hospital MACE in Cox regression (HRs [95%CIs] were 1.17 [0.95-1.42] for STEMI and 0.81 [0.55-1.19] for NSTEMI), in PSM (1.17 [0.94-1.45] for STEMI and 0.79 [0.49-1.27] for NSTEMI), and in IPTW analysis (1.22 [0.95-1.58] for STEMI and 0.87 [0.55-1.37] for NSTEMI). Conclusions: There was no significant difference in the risk of in-hospital MACE between directly admitted and transferred patients with AMI in China. Therefore, when direct admission is not feasible, timely transfer to PCI-capable hospitals maybe an alternative in real-world practice.