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Transfer times and outcomes in patients with ST-segment-elevation myocardial infarction undergoing interhospital transfer for primary percutaneous coronary intervention: APEX-AMI insights.

Publication ,  Journal Article
van Diepen, S; Widimsky, P; Lopes, RD; White, KR; Weaver, WD; Van de Werf, F; Ardissino, D; van't Hof, AWJ; Armstrong, PW; Granger, CB
Published in: Circ Cardiovasc Qual Outcomes
July 1, 2012

BACKGROUND: Transfer delays for primary percutaneous coronary intervention may increase mortality in patients with ST-segment-elevation myocardial infarction. We examined the association between door 1-to-door 2 (D1D2) time, a measure capturing the entire transfer process, and outcomes in patients undergoing interhospital transfer for primary percutaneous coronary intervention. METHODS AND RESULTS: We evaluated the relationship between D1D2 time and the 90-day incidence of death, shock, and heart failure in the subset of 2075 (36.1%) of 5745 patients who underwent interhospital transfer for primary percutaneous coronary intervention in the Assessment of Pexelizumab in Acute Myocardial Infarction trial. There was no significant difference in the 90-day incidence of death, shock, and heart failure between the transferred and the nontransferred groups (10.3% versus 10.2%; P = 0.89). The median difference in symptom-to-balloon time between the 2 groups was 45 minutes (229 versus 184; P<0.001). The primary outcome per 30-minute delay was higher for patients with a D1D2 time ≤150 minutes (hazard ratio, 1.19: 95% confidence interval, 1.06 to 1.33; P = 0.004) but not for D1D2 times >150 minutes (hazard ratio, 0.99: 95% confidence interval, 0.96 to 1.02; P = 0.496). The association between longer D1D2 time and worsening outcome was no longer statistically significant after multivariable adjustment. CONCLUSIONS: Longer transfer times were associated with higher rate of death, shock, and heart failure among patients undergoing interhospital transfer from primary percutaneous coronary intervention, although this difference did not persist after adjusting for baseline characteristics.

Duke Scholars

Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

July 1, 2012

Volume

5

Issue

4

Start / End Page

437 / 444

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time-to-Treatment
  • Time Factors
  • Survival Analysis
  • Single-Chain Antibodies
  • Shock
  • Risk Factors
  • Risk Assessment
  • Prospective Studies
  • Proportional Hazards Models
 

Citation

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van Diepen, S., Widimsky, P., Lopes, R. D., White, K. R., Weaver, W. D., Van de Werf, F., … Granger, C. B. (2012). Transfer times and outcomes in patients with ST-segment-elevation myocardial infarction undergoing interhospital transfer for primary percutaneous coronary intervention: APEX-AMI insights. Circ Cardiovasc Qual Outcomes, 5(4), 437–444. https://doi.org/10.1161/CIRCOUTCOMES.112.965160
Diepen, Sean van, Petr Widimsky, Renato D. Lopes, Kyle R. White, W Douglas Weaver, Frans Van de Werf, Diego Ardissino, Arnoud W. J. van’t Hof, Paul W. Armstrong, and Christopher B. Granger. “Transfer times and outcomes in patients with ST-segment-elevation myocardial infarction undergoing interhospital transfer for primary percutaneous coronary intervention: APEX-AMI insights.Circ Cardiovasc Qual Outcomes 5, no. 4 (July 1, 2012): 437–44. https://doi.org/10.1161/CIRCOUTCOMES.112.965160.
van Diepen S, Widimsky P, Lopes RD, White KR, Weaver WD, Van de Werf F, et al. Transfer times and outcomes in patients with ST-segment-elevation myocardial infarction undergoing interhospital transfer for primary percutaneous coronary intervention: APEX-AMI insights. Circ Cardiovasc Qual Outcomes. 2012 Jul 1;5(4):437–44.
van Diepen, Sean, et al. “Transfer times and outcomes in patients with ST-segment-elevation myocardial infarction undergoing interhospital transfer for primary percutaneous coronary intervention: APEX-AMI insights.Circ Cardiovasc Qual Outcomes, vol. 5, no. 4, July 2012, pp. 437–44. Pubmed, doi:10.1161/CIRCOUTCOMES.112.965160.
van Diepen S, Widimsky P, Lopes RD, White KR, Weaver WD, Van de Werf F, Ardissino D, van’t Hof AWJ, Armstrong PW, Granger CB. Transfer times and outcomes in patients with ST-segment-elevation myocardial infarction undergoing interhospital transfer for primary percutaneous coronary intervention: APEX-AMI insights. Circ Cardiovasc Qual Outcomes. 2012 Jul 1;5(4):437–444.

Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

July 1, 2012

Volume

5

Issue

4

Start / End Page

437 / 444

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time-to-Treatment
  • Time Factors
  • Survival Analysis
  • Single-Chain Antibodies
  • Shock
  • Risk Factors
  • Risk Assessment
  • Prospective Studies
  • Proportional Hazards Models