Skip to main content
PMC home page
Heart logoLink to Heart
. 1999 Oct;82(4):415–419. doi: 10.1136/hrt.82.4.415

Hospital transfer for primary coronary angioplasty in high risk patients with acute myocardial infarction

E Straumann 1, S Yoon 1, B Naegeli 1, J Frielingsdorf 1, A Gerber 1, E Schuiki 1, O Bertel 1
PMCID: PMC1760280  PMID: 10490552

Abstract

OBJECTIVE—To investigate the feasibility, safety, and associated time delays of interhospital transfer in patients with acute myocardial infarction for primary percutaneous transluminal coronary angioplasty (PTCA).
DESIGN AND PATIENTS—Prospective observational study with group comparison in a single centre. 68 consecutive patients with acute myocardial infarction transferred for primary PTCA from other hospitals (group A) were compared with 78 patients admitted directly to the referral centre (group B).
MAIN OUTCOME MEASURES—Patient groups were analysed with regard to baseline characteristics, time intervals from onset of chest pain to balloon angioplasty, hospital stay, and follow up outcome.
RESULTS—Patients in group A presented with a higher rate of cardiogenic shock initially than patients in group B (25% v 6%, p = 0.01) and had been resuscitated more frequently before PTCA (22% v 5%, p = 0.01). No deaths or other serious complications occurred during interhospital transfer. Median transfer time was 63 (range 40-115) minutes for helicopter transport (median 42 (28-122) km, n = 14), and 50 (18-110) minutes by ground ambulance (median 8 (5-68) km, n = 54). The median time interval from the decision to perform coronary arteriography to balloon inflation was 96 (45-243) minutes in group A and 52 (17-214) minutes in group B (p = 0.0001). In transferred patients (group A) the transportation associated delay and the longer in-hospital median decision time (50 (10-1120) minutes in group A v 15 (0-210) minutes in group B, p = 0.002) concurred with a longer total period of ischaemia (239 (114-1307) minutes in group A v 182 (75-1025) minutes in group B, p = 0.02) since the beginning of chest pain. Success of PTCA (TIMI 3 flow in 95% of all patients), in-hospital mortality (7% v 9%, mortality for patients not in cardiogenic shock 0% v 4%), and follow up after median 235 days was similarly favourable in groups A and B, respectively. Only one hospital survivor (group A) died during follow up.
CONCLUSION—Interhospital transport for primary PTCA in high risk patients with acute myocardial infarction is safe and feasible within a reasonable period of time. Short and medium term outcome is favourable. Optimising the decision process and transport logistics may further improve outcome by reducing the total time of ischaemia.


Keywords: acute myocardial infarction; primary percutaneous transluminal coronary angioplasty; hospital transfer; time delay

Full Text

The Full Text of this article is available as a PDF (72.9 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Antoniucci D., Valenti R., Santoro G. M., Bolognese L., Trapani M., Moschi G., Fazzini P. F. Systematic direct angioplasty and stent-supported direct angioplasty therapy for cardiogenic shock complicating acute myocardial infarction: in-hospital and long-term survival. J Am Coll Cardiol. 1998 Feb;31(2):294–300. doi: 10.1016/s0735-1097(97)00496-8. [DOI] [PubMed] [Google Scholar]
  2. Bellinger R. L., Califf R. M., Mark D. B., Weber R. A., Collins P., Stone J., Phillips H. R., 3rd, German L., Stack R. S. Helicopter transport of patients during acute myocardial infarction. Am J Cardiol. 1988 Apr 1;61(10):718–722. doi: 10.1016/0002-9149(88)91054-5. [DOI] [PubMed] [Google Scholar]
  3. Bode C., Smalling R. W., Berg G., Burnett C., Lorch G., Kalbfleisch J. M., Chernoff R., Christie L. G., Feldman R. L., Seals A. A. Randomized comparison of coronary thrombolysis achieved with double-bolus reteplase (recombinant plasminogen activator) and front-loaded, accelerated alteplase (recombinant tissue plasminogen activator) in patients with acute myocardial infarction. The RAPID II Investigators. Circulation. 1996 Sep 1;94(5):891–898. doi: 10.1161/01.cir.94.5.891. [DOI] [PubMed] [Google Scholar]
  4. Cannon C. P., McCabe C. H., Gibson C. M., Ghali M., Sequeira R. F., McKendall G. R., Breed J., Modi N. B., Fox N. L., Tracy R. P. TNK-tissue plasminogen activator in acute myocardial infarction. Results of the Thrombolysis in Myocardial Infarction (TIMI) 10A dose-ranging trial. Circulation. 1997 Jan 21;95(2):351–356. doi: 10.1161/01.cir.95.2.351. [DOI] [PubMed] [Google Scholar]
  5. Grines C. L., Browne K. F., Marco J., Rothbaum D., Stone G. W., O'Keefe J., Overlie P., Donohue B., Chelliah N., Timmis G. C. A comparison of immediate angioplasty with thrombolytic therapy for acute myocardial infarction. The Primary Angioplasty in Myocardial Infarction Study Group. N Engl J Med. 1993 Mar 11;328(10):673–679. doi: 10.1056/NEJM199303113281001. [DOI] [PubMed] [Google Scholar]
  6. Kovack P. J., Rasak M. A., Bates E. R., Ohman E. M., Stomel R. J. Thrombolysis plus aortic counterpulsation: improved survival in patients who present to community hospitals with cardiogenic shock. J Am Coll Cardiol. 1997 Jun;29(7):1454–1458. doi: 10.1016/s0735-1097(97)82537-5. [DOI] [PubMed] [Google Scholar]
  7. Lefkovits J., Ivanhoe R. J., Califf R. M., Bergelson B. A., Anderson K. M., Stoner G. L., Weisman H. F., Topol E. J. Effects of platelet glycoprotein IIb/IIIa receptor blockade by a chimeric monoclonal antibody (abciximab) on acute and six-month outcomes after percutaneous transluminal coronary angioplasty for acute myocardial infarction. EPIC investigators. Am J Cardiol. 1996 May 15;77(12):1045–1051. doi: 10.1016/s0002-9149(96)00128-2. [DOI] [PubMed] [Google Scholar]
  8. Neumann F. J., Walter H., Richardt G., Schmitt C., Schömig A. Coronary Palmaz-Schatz stent implantation in acute myocardial infarction. Heart. 1996 Feb;75(2):121–126. doi: 10.1136/hrt.75.2.121. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Ohman E. M., George B. S., White C. J., Kern M. J., Gurbel P. A., Freedman R. J., Lundergan C., Hartmann J. R., Talley J. D., Frey M. J. Use of aortic counterpulsation to improve sustained coronary artery patency during acute myocardial infarction. Results of a randomized trial. The Randomized IABP Study Group. Circulation. 1994 Aug;90(2):792–799. doi: 10.1161/01.cir.90.2.792. [DOI] [PubMed] [Google Scholar]
  10. Serruys P. W., Kay I. P. Cardiogenic shock: a failure in reperfusion. Time for a strategic change? Eur Heart J. 1999 Jan;20(2):88–89. [PubMed] [Google Scholar]
  11. Simes R. J., Topol E. J., Holmes D. R., Jr, White H. D., Rutsch W. R., Vahanian A., Simoons M. L., Morris D., Betriu A., Califf R. M. Link between the angiographic substudy and mortality outcomes in a large randomized trial of myocardial reperfusion. Importance of early and complete infarct artery reperfusion. GUSTO-I Investigators. Circulation. 1995 Apr 1;91(7):1923–1928. doi: 10.1161/01.cir.91.7.1923. [DOI] [PubMed] [Google Scholar]
  12. Villanueva F. S., Jankowski R. J., Klibanov S., Pina M. L., Alber S. M., Watkins S. C., Brandenburger G. H., Wagner W. R. Microbubbles targeted to intercellular adhesion molecule-1 bind to activated coronary artery endothelial cells. Circulation. 1998 Jul 7;98(1):1–5. doi: 10.1161/01.cir.98.1.1. [DOI] [PubMed] [Google Scholar]
  13. Weaver W. D., Simes R. J., Betriu A., Grines C. L., Zijlstra F., Garcia E., Grinfeld L., Gibbons R. J., Ribeiro E. E., DeWood M. A. Comparison of primary coronary angioplasty and intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review. JAMA. 1997 Dec 17;278(23):2093–2098. [PubMed] [Google Scholar]
  14. Zijlstra F., de Boer M. J., Hoorntje J. C., Reiffers S., Reiber J. H., Suryapranata H. A comparison of immediate coronary angioplasty with intravenous streptokinase in acute myocardial infarction. N Engl J Med. 1993 Mar 11;328(10):680–684. doi: 10.1056/NEJM199303113281002. [DOI] [PubMed] [Google Scholar]
  15. Zijlstra F., van 't Hof A. W., Liem A. L., Hoorntje J. C., Suryapranata H., de Boer M. J. Transferring patients for primary angioplasty: a retrospective analysis of 104 selected high risk patients with acute myocardial infarction. Heart. 1997 Oct;78(4):333–336. doi: 10.1136/hrt.78.4.333. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Heart are provided here courtesy of BMJ Publishing Group

RESOURCES