Transfer for Direct Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction: the Minneapolis Heart Institute Level 1 Myocardial Infarction Program
Study of:
Background:
Direct PCI for STEMI is superior when performed in a timely manner in high volume centers, but 75% of STEMI patients present initially to non PCI hospitals. We developed an integrated system for transfer of STEMI patients for direct PCI. After an initial pilot program, the protocol has been implemented in 31 hospitals up to 200 miles from Minneapolis. Currently >40 STEMI patients/month are being treated.
Methods:
Abbott Northwestern (ANW) Hospital is a tertiary cardiac center in Minneapolis. The “Level 1” MI protocol includes immediate activation of the transport services, mobilization of the cath lab team and administration of adjunctive treatment following an established protocol. Hospitals <60 miles away receive direct PCI (Zone 1). Hospitals 60-200 miles away (Zone 2) use a facilitated approach with ½ dose TNK prior to transfer.
Results:
From 3/03 to 5/05, 448 STEMI pts were transferred for direct or primary PCI by ambulance (n=149) or helicopter (n=299). During the same period, 145 STEMI pts presented directly to ANW. There were no deaths during transfer. No patients were excluded including cardiogenic shock (13.7%), cardiac arrest (9.9%) and elderly (17% >80). Despite the high risk unselected patient population, in hospital mortality was only 3.5% with median length of stay of 3 days. Door to balloon times (mins) and 30 day outcomes (no significant difference) are shown in the Table.
|
|
In door 1-out door 1 |
Transport time |
In door 2-balloon |
Total door-balloon |
Mortality at 30 days |
Stroke at 30 days |
Reinfarction at 30 days |
|
ANW (145) |
NA |
NA |
67 |
67 |
6.2% |
1.4% |
2.8% |
|
Zone 1 (301) |
47 |
22 |
22 |
97 |
4.3% |
1.3% |
1.0% |
|
Zone 2 (147) |
57 |
31 |
20 |
117 |
3.4% |
0.0% |
0.0% |
Conclusion:
Rapid transfer of STEMI patients from community hospitals up to 200 miles from PCI centers in the US is safe and effective with an integrated system of acute cardiac care. Outcomes for transferred patients are similar to those who present to PCI centers directly.
Timothy D. Henry, MD, FACC
Daniel Lips, MD, FACC
Wesley R. Pedersen, MD, FACC
Scott W. Sharkey, MD, FACC
Yale Wang, MD, FACC, FSCAI
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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