Primary versus secondary transport of STEMI patients: impact on transport times and mortality

Abstract

Background: The door-balloon time (DBT) is linked to morbidity and mortality of patients with ST segment elevation myocardial infarction (STEMI). Despite preferable direct transport to catheterization laboratory (PT), still significant proportion of STEMI patients is transported via non-PCI regional hospitals or Coronary Care Units (ST) prior to percutaneous coronary intervention (PCI). This study assessed to what extent PT vs ST affects the DBT and mortality. Methods: Our region with 600 000 inhabitants uses well elaborated 24hours/365 days system of immediate transport of all patients with STEMI lasting less than 12 hours to referral catheterization laboratories in the tertiary University Hospital Cardiac Center for more than 15 years. We prospectively recorded DBT of 677 consecutive patients with STEMI, treated by PCI in the years 2008-2009. Consequent follow-up was obtained in all patients. Results: Median of DBT was 34±15.9 mins for PT patients (n=354) and 100±28.8 mins for patients with ST (n=323) (p<0.005). One-month mortality was 4% vs 9.5% (p=0.002) in the PT vs ST group, respectively. One-year mortality in the PT and ST groups was 7.3 vs 20.5% (p<0.005), respectively. ![Figure][1] One-year mortality (\***|p<0.05) Conclusion: The admission of patients with STEMI to regional hospitals or Coronary Care Units instead of direct transport to catheterization laboratory significantly prolongs the DBT and increases mortality. [1]: pending:yes