Transfer for urgent percutaneous coronary intervention early after thrombolysis for ST-elevation myocardial infarction: The TRANSFER-AMI pilot feasibility study

Background Most hospitals in Canada do not have percutaneous coronary intervention (PCI) facilities and use thrombolysis as reperfusion therapy for ST-elevation myocardial infarction (STEMI). Urgent PCI after thrombolysis may optimize reperfusion and prevent reinfarction and recurrent ischemia. Objective To determine the feasibility of transferring high-risk STEMI patients from community hospitals in Ontario to PCI centres for urgent PCI within 6h of thrombolysis. Methods Patients with anterior or high-risk inferior STEMI received tenecteplase and were urgently transferred to PCI centres. PCI was performed if at least 70% stenosis was present in the infarctrelated artery, regardless of flow, using coronary stents. Transfer of stable patients back to community hospitals was encouraged 24h to 48h after PCI. Results Eighteen patients were transferred and underwent PCI a median of 3.9h (range 2.7h to 6.4h) after thrombolysis. No complications occurred during transfer. One death occurred that was related to failed reperfusion and cardiogenic shock. Minor access-site bleeding occurred in five patients. Fifteen patients were transferred back to their community hospitals within 24h of PCI. There were no further deaths or reinfarctions at one-year follow-up. Conclusions Transfer of high-risk STEMI patients for urgent PCI within 6h after thrombolysis appears feasible. The randomized trial phase of the Trial of Routine ANgioplasty and Stenting after Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction (TRANSFER-AMI) will compare this strategy with standard treatment after thrombolysis.