Skip to main content

Advertisement

SpringerLink
Log in

Direct admission versus transfer of AMI patients for primary PCI

  • Original Paper
  • Published:
Clinical Research in Cardiology Aims and scope Submit manuscript

Abstract

Background

Guidelines for the treatment of patients with ST-elevation myocardial infarction (STEMI) recommend primary PCI as first choice therapy. This recommendation has been linked to defined time limits achievable in a logistic network for the treatment of ACS. In the present study we analyzed the difference in 6 months outcome between STEMI patients who were admitted directly to a PCI center and those requiring transfer for primary PCI.

Results

2,034 consecutive patients were included in the Bad Nauheim ACS registry. Admission diagnosis was STEMI in 1,057 (52%) patients (71% male, aged 63 ± 13). 637 (60%) patients were directly admitted for primary PCI with a time delay from first medical contact until admission in the PCI center of 64 min (IQR 45–90) at median and door-to-balloon time (DTB) at median 29 min (IQR 20–41). 420 (40%) patients were transferred from peripheral hospitals. In this subgroup time delay was 135 min (IQR 69–285) and DTB at median 31 min (IQR 22–49). 178 (16.8%) patients were at high risk (CPR or cardiogenic shock). Patients, who were admitted directly had a better outcome as transferal patients (log rank 6.1; p = 0.013 for 6 months mortality). However, Kaplan–Meier survival analysis (log rank 4.25; p = 0.039) and Cox regression analysis (95% CI 1.08–3.17; p = 0.026) revealed that this difference in outcome was restricted to high-risk patients.

Conclusion

A network for the treatment of STEMI provides the logistic basis for the initiation of primary PCI according to current guidelines. However, transferal patients do not meet the defined time limits. Mortality rates for high-risk transferal patients appear to be higher as those of patients taken directly to the center by the EMS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Nallamothu BK, Bradley EH, Krumholz HM (2007) Time to treatment in primary percutaneous coronary intervention. N Engl J Med 357(16):1631–1638

    Article  CAS  PubMed  Google Scholar 

  2. Brodie BR, Hansen C, Stuckey TD et al (2006) Door-to-balloon time with primary percutaneous coronary intervention for acute myocardial infarction impacts late cardiac mortality in high-risk patients and patients presenting early after the onset of symptoms. J Am Coll Cardiol 47:289–295

    Article  PubMed  Google Scholar 

  3. Terkelsen CJ, Christiansen EH, Sørensen JT et al (2009) Primary PCI as the preferred reperfusion therapy in STEMI: it is a matter of time. Heart 95(5):362–369

    Article  CAS  PubMed  Google Scholar 

  4. De Luca G, Biondi-Zoccai G, Marino P (2008) Transferring patients with ST-segment elevation myocardial infarction for mechanical reperfusion: a meta-regression analysis of randomized trials. Ann Emerg Med 52:665–676

    Article  PubMed  Google Scholar 

  5. Cantor WJ, Fitchett D, Borgundvaag B, for the TRANSFER-AMI Trial Investigators et al (2009) Routine early angioplasty after fibrinolysis for acute myocardial infarction. N Eng J Med 360:2705–2718

    Article  Google Scholar 

  6. Zahn R, Schiele R, Gitt AK, for the Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) and the Myocardial Infarction Registry (MIR) Study Groups et al (2001) Impact of prehospital delay on mortality in patients with acute myocardial infarction treated with primary angioplasty and intravenous thrombolysis. Am Heart J 142:105–111

    Article  CAS  PubMed  Google Scholar 

  7. Zimmermann S, Ruthrof S, Nowak K, Alff A, Klinghammer L, Schneider R, Ludwig J, Pfahlberg AB, Daniel WG, Flachskampf FA (2009) Short-term prognosis of contemporary interventional therapy of ST-elevation myocardial infarction: does gender matter? Clin Res Cardiol 98:709–715

    Article  PubMed  Google Scholar 

  8. The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology, Van de Werf F, Bax J, Betriu A et al (2008) Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation. Eur Heart J 29:2909–2945

    Article  PubMed  Google Scholar 

  9. Bonzel T, Erbel R, Hamm CW et al (2008) Leitlinie Perkutane Koronarintervention (PCI). Clin Res Cardiol 97:513–547

    Article  PubMed  Google Scholar 

  10. Nieminen MS, Böhm M, Cowie MR, ESC Committee for Practice Guideline (CPG) et al (2005) Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: the Task Force on Acute Heart Failure of the European Society of Cardiology. Eur Heart J 26(4):384–416

    Article  PubMed  Google Scholar 

  11. Wienbergen H, Gitt AK, Senges J (2005) Aktuelle Umsetzung der leitlinienkonformen Therapie des akuten ST-Strecken-Hebungsinfarkts in Deutschland. Herz 30:700–703

    Article  PubMed  Google Scholar 

  12. Maier B, Behrens S, Grafe-Bothe C, Kuckuck H, Roehnisch JU, Schoeller RG, Schuelen H, Theres HP (2010) Time of admission, quality of PCI care, and outcome of patients with ST-elevation myocardial infarction. Clin Res Cardiol 99(9):565–572

    Article  PubMed  Google Scholar 

  13. Krüth P, Zeymer U, Gitt A, Jünger C, Wienbergen H, Niedermeier F, Glunz HG, Senges J, Zahn R (2008) Influence of presentation at the weekend on treatment and outcome in ST-elevation myocardial infarction in hospitals with catheterization laboratories. Clin Res Cardiol 97:742–747

    Article  PubMed  Google Scholar 

  14. Bradley EH, Herrin J, Wang Y et al (2006) Strategies for reducing the door-to-balloon time in acute myocardial infarction. N Engl J Med 355:2308–2320

    Article  CAS  PubMed  Google Scholar 

  15. Dudek D, Siudak Z, Dziewierz A et al (2008) Local hospital networks for STEMI treatment for a population of half a million inhabitants increase the use of invasive treatment of acute coronary syndromes to the European recommended level. The Małopolska Registry of Acute Coronary Syndromes 2005–2006. Kardiol Pol 66:489–497

    PubMed  Google Scholar 

  16. Schneider H, Ince H, Rehders T, Drip&Ship-Netzwerk (District of Rostock Infarct Project & Shipping Patients) et al (2007) Treatment of acute ST elevation myocardial infarction in a regional network (“Drip & Ship Network Rostock”). Herz 32(8):635–640

    Article  PubMed  Google Scholar 

  17. Bauer T, Hoffmann R, Jünger C, Koeth O, Zahn R, Gitt A, Heer T, Bestehorn K, Senges J, Zeymer U (2009) Efficacy of a 24-h primary percutaneous coronary intervention service on outcome in patients with ST-elevation myocardial infarction in clinical practice. Clin Res Cardiol 98:171–178

    Article  PubMed  Google Scholar 

  18. Dhruva VN, Abdelhadi SI, Anis A et al (2007) ST-segment Analysis Using Wireless Technology in Acute Myocardial Infarction (STAT-MI) trial. J Am Coll Cardiol 50:509

    Article  PubMed  Google Scholar 

  19. Strauß M, Gitt AK, Becker T, Kleemann T, Schiele R, Darius H, Juenger C, Senges J, Seidl K for the MITRA PLUS study group (2008) Prehospital cardiac arrest: a marker for higher mortality in patients with acute myocardial infarction and moderately reduced left ventricular function: results from the MITRA plus registry. Clin Res Cardiol 97:748–752

    Article  PubMed  Google Scholar 

  20. Dong-bao L, Qi H, Zhi L, Shan W, Wei-ying J (2009) Predictors and short-term prognosis of angiographically detected distal embolization after emergency percutaneous coronary intervention for ST-elevation acute myocardial infarction. Clin Res Cardiol 98:773–779

    Article  PubMed  Google Scholar 

  21. Kammler J, Kypta A, Hofmann R, Kerschner K, Grund M, Sihorsch K, Steinwender C, Lambert T, Helml W, Leisch F (2009) TIMI 3 flow after primary angioplasty is an important predictor for outcome in patients with acute myocardial infarction. Clin Res Cardiol 98:165–170

    Article  PubMed  Google Scholar 

  22. De Luca G, Suryapranata H, Marino P (2008) Reperfusion strategies in acute ST-elevation myocardial infarction: an overview of current status. Prog Cardiovasc Dis 50(5):352–382

    Article  PubMed  Google Scholar 

  23. Koeth O, Zahn R, Heer T, Bauer T, Juenger C, Klein B, Gitt AK, Senges J, Zeymer U (2009) Gender differences in patients with acute ST-elevation myocardial infarction complicated by cardiogenic shock. Clin Res Cardiol 98:781–786

    Article  CAS  PubMed  Google Scholar 

  24. Assessment of the Safety and Efficacy of a New Treatment Strategy with Percutaneous Coronary Intervention (ASSENT-4 PCI) Investigators (2006) Primary versus tenecteplase-facilitated percutaneous coronary intervention in patients with ST-segment elevation acute myocardial infarction (ASSENT-4 PCI): randomized trial. Lancet 367:569–578

    Article  Google Scholar 

  25. Di Mario C, Dudek D, Piscione F, CARESS-in-AMI (Combined Abciximab RE-teplase Stent Study in Acute Myocardial Infarction) Investigators et al (2008) Immediate angioplasty versus standard therapy with rescue angioplasty after thrombolysis in the Combined Abciximab REteplase Stent Study in Acute Myocardial Infarction (CARESS-in-AMI): an open, prospective, randomised, multicentre trial. Lancet 371(9612):559–568

    Article  CAS  PubMed  Google Scholar 

  26. Ellis SG, Tendera M, de Belder MA, van Boven AJ, Widimsky P, Janssens L, Andersen HR, Betriu A, Savonitto S, Damaus J, Peruga JZ, Kosmider M, Katz O, Neunteufl T, Jorgova J, Dorobantu M, Grinfeld L, Armstrong P, Brodie BR, Herrmann HC, Montalescot G, Neumann FJ, Effron MB, Barnathan ES, Topol EJ, FINESSE Investigators (2008) Facilitated PCI in patients with ST-elevation myocardial infarction. N Engl J Med 358(21):2205–2217

    Article  CAS  PubMed  Google Scholar 

  27. Mehta RH, Harjai KJ, Cox D, Primary Angioplasty in Myocardial Infarction (PAMI) Investigators et al (2003) Clinical and angiographic correlates and outcomes of suboptimal coronary flow in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. J Am Coll Cardiol 42:1739–1746

    Article  PubMed  Google Scholar 

  28. Keeley EC, Boura JA, Grines CL (2003) Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet 361:13–20

    Article  PubMed  Google Scholar 

  29. Andersen HR, Nielsen TT, Rasmussen K, DANAMI-2 Investigators et al (2003) A comparison of coronary angioplasty with fibrinolytic therapy in acute myocardial infarction. N Eng J Med 349:733–742

    Article  Google Scholar 

  30. Widimský P, Budesínský T, Vorác D, ‘PRAGUE’ Study Group Investigators et al (2003) Long distance transport for primary angioplasty vs. immediate thrombolysis in acute myocardial infarction. Final results of the randomized national multicentre trial–PRAGUE-2. Eur Heart J 24(1):94–104

    Article  PubMed  Google Scholar 

  31. BØhmer E, Hoffmann P, Abdelnoor M et al (2010) Efficacy and safety of immediate angioplasty versus ischemia-guided management after thrombolysis in acute myocardial infarction in areas with very long transfer distances results of the NORDISTEMI (NORwegian study on District treatment of ST-elevation myocardial infarction). J Am Coll Cardiol 55(2):102–110

    Article  PubMed  Google Scholar 

  32. Bauer T, Möllmann H, Weidinger F et al (2010) Use of platelet glycoprotein IIb/IIIa inhibitors in diabetics undergoing PCI for non-ST-segment elevation acute coronary syndromes: impact of clinical status and procedural characteristics. Clin Res Cardiol 99:275–383

    Article  Google Scholar 

  33. Busk M, Maeng M, Rasmussen K, DANAMI-2 Investigators et al (2008) The Danish multicentre randomized study of fibrinolytic therapy vs. primary angioplasty in acute myocardial infarction (the DANAMI-2 trial): outcome after 3 years follow-up. Eur Heart J 29(10):1259–1266

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestr. 2-8, 61231, Bad Nauheim, Germany

    Christoph Liebetrau, Sebastian Szardien, Johannes Rixe, Mariella Woelken, Andreas Rolf, Holger Nef, Helge Möllmann, Christian Hamm & Michael Weber

  2. Herzzentrum Ludwigshafen, Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen, Germany

    Timm Bauer

Authors
  1. Christoph Liebetrau
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sebastian Szardien
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Johannes Rixe
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mariella Woelken
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andreas Rolf
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Timm Bauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Holger Nef
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Helge Möllmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Christian Hamm
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Michael Weber
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christoph Liebetrau.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Liebetrau, C., Szardien, S., Rixe, J. et al. Direct admission versus transfer of AMI patients for primary PCI. Clin Res Cardiol 100, 217–225 (2011). https://doi.org/10.1007/s00392-010-0231-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-010-0231-x

Keywords

Search

Navigation