Long Distance Transfer for Direct Percutaneous Coronary Intervention: A Facilitated Approach
Study of:
Long Distance Transfer for Direct Percutaneous Coronary Intervention
Background:
Primary percutaneous coronary intervention (PCI) is superior for STEMI if performed in a timely manner at experienced centers. The benefit of primary PCI over fibrinolysis may be lost as distance/time from a PCI center increases. Combining reduced dose fibrinolytic prior to transfer results in establishment of earlier reperfusion. A facilitated PCI approach may provide equivalent outcomes to primary PCI in patients when delays in transfer occur.
Methods:
We report clinical outcomes, door to balloon times and pre-procedural TIMI flow in STEMI patients who were transferred for facilitated PCI (1/2 dose TNK) to Abbott Northwestern Hospital (ANW) from 17 hospitals 60-210 miles away compared to 158 patients who presented to ANW directly.
Results: From 7/03 to 9/05 210 STEMI patients were transferred to ANW by helicopter (96%) or ground ambulance (4%) for facilitated PCI (34 patients with lytic contraindications received primary PCI). No patients were excluded including cardiogenic shock (12%), cardiac arrest (10%) or mechanical ventilation (7%). Facilitated PCI had longer median door to balloon times (117 vs 66 mins, p<0.0001) but also had greater infarct artery patency pre-PCI (72% vs 31%, p<0.0001).
|
|
Pre TIMI 3/2 (%) |
Post TIMI 3 |
Stroke at 30 days |
Reinfarction / ischemia at 30 days |
Mortality at 30 days |
Major bleeding |
|
Facil. PCI n=176 |
43/29 |
96% |
0 |
0 |
3.8% |
0 |
|
ANW n=158 |
15/16 |
93% |
2.5% |
3.8% |
6.3% |
0 |
|
p-value |
<0.0001 |
NS |
NS |
NS |
NS |
NS |
Conclusions:
Rapid transfer of STEMI patients from distances of 60-210 miles for facilitated PCI using a protocol of reduced dose fibrinolytics is safe and feasible with equivalent outcomes to those who present to a primary PCI center directly.
M. Nicholas Burke, MD
Timothy D. Henry, MD, FACC
Anil K. Poulose, MD, FACC
Scott W. Sharkey, MD, FACC
Katie Menssen
Barbara Unger, RN, BS, FAACVPR
For more information about this study or other research studies at the Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, please contact Katie Menssen at 612-775-3052.
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