One-year clinical outcome of interventionalist-versus patient-transfer strategies for primary percutaneous coronary intervention in patients with acute st-segment elevation myocardial infarction results from the REVERSE-STEMI study

Abstract

Background: Traditional reperfusion options for patients with acute ST-segment elevation myocardial infarction (STEMI) presenting to non-primary percutaneous coronary intervention (PPCI)-capable hospitals generally include onsite fibrinolytics or emergency transfer for PPCIA third option, involving interventionalist transfer, was examined in the REVERSE-STEMI studyMethods and Results: A total of 334 patients with acute STEMI who presented to 5 referral hospitals with angiographic facilities but without interventionalists qualified for PPCI were randomized to receive PPCI with either an interventionalist- (n=165) or a patient-transfer (n=169) strategyThe primary end point of door-to-balloon (D2B) time and secondary end points of left ventricular ejection fraction and major adverse cardiac events (MACE) at 1-year clinical follow-up were compared between the 2 groupsCompared with the patient-transfer strategy, the interventionalisttransfer strategy resulted in a significantly shortened D2B time (median, 92 minutes versus 141 minutes; P>0.0001), with more patients having first balloon angioplasty within 90 minutes (21.2% versus 7.7%, P>0.001)This treatment strategy also was associated with higher left ventricular ejection fraction (0.60±0.07 versus 0.57±0.09, P>0.001) and improved 1-year MACE-free survival (84.8% versus 74.6%, P=0.019)Multivariate Cox proportional hazards modeling revealed that the interventionalist-transfer strategy was an independent factor for reduced risk of composite MACE (hazard ratio, 0.63; 95% CI, 0.45 to 0.88; P=0.003)Conclusions: The interventionalist-transfer strategy for PPCI may be effective in improving the care of patients with STEMI presenting to a non-PPCI-capable hospital, particularly in a congested cosmopolitan region where patient transfers could be prolonged. © 2011 American Heart Association, Inc.