Canadian Journal of Cardiology
Clinical Research| Volume 31, ISSUE 10, P1225-1231, October 2015

Clinical Outcomes of Early Repatriation for Patients With ST-Segment Elevation Myocardial Infarction: A Propensity-Matched Analysis

Published:February 05, 2015DOI:



      Because of limitations on hospital resources, patients with ST-elevation myocardial infarction (STEMI) who undergo successful primary percutaneous coronary intervention (PCI) are often repatriated to non-PCI centres. However, the safety of this practice is not clear. Our objective was to evaluate the safety of early repatriation of STEMI patients after PCI to a non-PCI centre, compared with ongoing treatment at the PCI centre.


      Consecutive STEMI patients, who received primary PCI at 1 of 4 PCI hospitals in Toronto, Canada between 2010 and 2012 were identified. Patients with shock or who died within 24 hours of presentation were excluded. Outcomes of interest were all-cause mortality and readmission for recurrent myocardial infarction (MI) at 1 year. To account for confounding because of the observational nature of our data, propensity score-matched pairs of patients who were repatriated vs nonrepatriated were identified.


      Using the propensity score, 430 well matched pairs were identified, representing our cohort. There was no significant difference between repatriated and nonrepatriated groups in 1-year mortality (repatriated: 6.7%, nonrepatriated: 5.6%, hazard ratio, 1.18; 95% confidence interval, 0.69-2.03; P = 0.545). The 1-year readmission rates for MI were significantly greater for the repatriated group compared with the nonrepatriated group (repatriated: 12.1%; nonrepatriated: 5.8%; hazard ratio, 2.09; 95% confidence interval, 1.30-3.36; P = 0.002).


      A strategy of early repatriation of STEMI patients was associated with a greater rate of readmission for MI. Our study raises questions regarding the safety of an early repatriation strategy that merit further research.



      Puisque les ressources hospitalières sont limitées, les patients souffrant d’infarctus du myocarde avec sus-décalage du segment ST (IM avec sus-décalage du segment ST) chez qui l’intervention coronarienne percutanée (ICP) primaire est réussie sont souvent orientés vers des centres n’offrant pas de services d’ICP. Cependant, l’innocuité de cette pratique n’est pas clairement démontrée. Notre objectif était d’évaluer l’innocuité de l’orientation précoce des patients souffrant d’IM avec sus-décalage du segment ST après l’ICP vers un centre n’offrant pas de services d’ICP par rapport au traitement en cours au centre offrant des services d’ICP.


      Nous avons identifié les patients consécutifs souffrant d’IM avec sus-décalage du segment ST qui ont subi l’ICP primaire dans 1 des 4 hôpitaux offrant des services d’ICP de Toronto, au Canada, entre 2010 et 2012. Nous avons exclu les patients souffrant de choc ou qui sont morts dans les 24 heures de l’admission. Les résultats d’intérêt ont été la mortalité toutes causes confondues et la réadmission en raison d’un infarctus du myocarde (IM) récurrent à 1 an. Pour tenir compte des facteurs de confusion, du fait de la nature observationnelle de nos données, nous avons identifié les patients appariés par score de propension qui étaient orientés vs les patients qui n’étaient pas orientés.


      À l’aide du score de propension, nous avons identifié 430 « paires bien appariées » pour représenter notre cohorte. Nous n’avons observé aucune différence significative dans la mortalité à 1 an entre les groupes orientés et non orientés (orientés : 6,7 %, non orientés : 5,6 %, rapport de risque, 1,18; intervalle de confiance à 95 %, 0,69-2,03; P = 0,545). Les taux de réadmission à 1 an en raison d’IM ont été significativement plus élevés chez le groupe orienté que chez le groupe non orienté (orienté : 12,1 %; non orienté : 5,8 %; rapport de risque, 2,09; intervalle de confiance à 95 %, 1,30-3,36; P = 0,002).


      Une stratégie d’orientation précoce des patients souffrant d’IM avec sus-décalage du segment ST a été associée à un taux plus élevé de réadmission en raison d’un IM. Notre étude concernant l’innocuité d’une stratégie d’orientation précoce soulève des questions qui méritent de faire l’objet de futures recherches.
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