Treatment of Acute Myocardial Infarction by Primary Angioplasty On-Site Compared With Treatment Following Interhospital Transfer: Short- and Long-Time Clinical Outcomes

Introduction and objectives Primary angioplasty is the treatment of first choice for patients with ST-segment elevation acute myocardial infarction. However, its use is limited as the majority of patients present at hospitals without a catheterization laboratory. The objective of this study was to determine shortand long-term outcomes of systematically implementing a primary angioplasty program at 2 hospitals, one of which did not have a catheterization laboratory. Methods This prospective observational study involved consecutive patients with acute myocardial infarction and an indication for reperfusion therapy who were admitted to the two participating hospitals (hospital 1 had a catheterization laboratory, while hospital 2 did not) between January 2000 and April 2001. Clinical follow-up was performed at 1, 6, and 12 months. Results The study included 222 patients: 158 in hospital 1 and 64 in hospital 2. The median (interquartile range) delays from door to angiography at hospital 1 and hospital 2 were 49.5 min (30.0–88.0 min) and 62.5 min (53.5–93.7 min), respectively (P=.001), and from symptoms to angiography, 162.5 min (105.0–247.5 min) and 187.5 min(131.2–288.7 min), respectively (P=.04). In-hospital and 1-year mortality rates were 12.2% and 15.3%, respectively, with no difference between the hospitals. The hospital of origin was not a determinant of either in-hospital mortality (odds ratio [OR],=1.42, 95% confidence interval [CI], 0.3–7.8) or 1-year mortality (HR,2.04, 95% CI, 0.74–5.61). Conclusions Patients with ST-segment elevation acute myocardial infarction who require interhospital transfer for primary angioplasty have a similar clinical outcome to those who are admitted to a hospital at which the procedure is available, provided transfer is undertaken under optimal conditions (ie, with a suitable means of transport and a short transfer time).