Assessing the Safety of Early Repatriation for Stable ST-Elevation Myocardial Infarction Patients After Primary Percutaneous Coronary Intervention

Abstract

BACKGROUNDRepatriation of ST-elevation myocardial infarction (STEMI) patients after primary percutaneous coronary intervention (PPCI) is common in regional healthcare programs. We examined the short- and long-term safety of early repatriation after PPCI in stable STEMI patients. METHODSConsecutive, stable STEMI patients undergoing PPCI between 2016-2018 in the Fraser Health Authority were included. Outcomes were compared between early and non-repatriated cohorts. Co-primary outcomes were a composite of death, myocardial infarction, congestive heart failure and stroke at 30-days and 1yr. Logistic regression analyses were performed to determine association between early repatriation and outcomes, and to assess impact of transfer to cardiologist- vs. internist-based care centres. RESULTSA total of 788 patients were included, with 62% being repatriated early. Primary composite and individual outcomes rates were similar between both cohorts. Early repatriation was not an independent predictor of 30-day (OR 0.93, 95% CI 0.50-1.72, p=0.82) and 1yr primary outcome (OR 1.05, 95% CI 0.67-1.65, p=0.8), or 30-day (OR 1.35, 95% CI 0.41-4.47, p=0.63) and 1yr mortality (OR 1.03, 95% CI 0.44-2.40, p=0.95). Amongst early repatriated patients, transfer to cardiologist vs. internist-based care centres was not an independent factor for 30-day (OR 1.07, 95% CI 0.45-2.54, p=0.87) or 1yr primary outcome (OR 1.17, 95% 0.55-2.50, p=0.69). CONCLUSIONEarly repatriation of stable STEMI patients after PPCI appears to be safe based on short- and long-term outcomes, while transfer to internist vs. cardiology-based centres did not impact outcomes. After PPCI, early repatriation allows for redistribution of stable STEMI patients to lower acuity settings across regional hospitals.