Abstract 9141: Distance, Treatment Strategy, and Mode of Transfer for Primary PCI in Patients Presenting to a Hospital Without PCI Capability: A Report from ACTION Registry®-GWTG™ and The AHA Mission: Lifeline Program

Abstract

Background: Many STEMI patients (pts) present to non-PCI hospitals, requiring interhospital transfer for primary PCI. The impact of distance and mode of transport to the PCI center on the ability to meet guideline recommended reperfusion times is not clear. Methods: Data from the ACTION Registry®-GWTG™ were used to determine reperfusion strategy (fibrinolytics, primary PCI), total time to reperfusion (Total D2B; difference between non-PCI hospital presenting time and PCI time) and transfer mode (ground, air) for pts having interhospital transfer for primary PCI. Distance between the pt’s home zip code and the PCI hospital zip code were used to estimate travel distance. Results: From 7/1/08-3/3/11, 13,974 STEMI pts were transferred to 323 PCI hospitals. The median distance from the pt’s home to the primary PCI hospital was 26 miles (IQR 13,40) (ground 20 mi; air 37 mi; p<.001). Pts transported by air had a similar median age (59 yrs), but were more likely to have heart failure (8.0% vs 6.4%; p<.01) and shock (8.9% vs 6.8%; p<0.001). The Total D2B time for the 11,722 pts transferred for primary PCI was 115 min (IQR 93,147), with air time significantly longer [median 123 min vs 110 min; p <0.001]. A total of 5,577 (56%) pts had a Total D2B ≤120 min, with only 2,215 (22%) ≤90 min. Total D2B time ≤120 min was more likely in ground pts (60% vs 47%; p <.001). At distances 25 mi, air transport predominated (TABLE). Fibrinolytic therapy administration increased as distance increased. Conclusions: Interhospital transfer for primary PCI is associated with prolonged reperfusion times, despite increased use of air transport for longer distance transfers. These delays should prompt increased consideration of fibrinolytic therapy use prior to transfer by some hospitals. Conversely, the relatively short distance most pts live from a primary PCI hospital should prompt greater emphasis on EMS hospital bypass protocols.