Centres that perform percutaneous coronary intervention (PCI) have resources specialized
in the care of ST-elevation myocardial infarction (STEMI) patients both during and
after PCI. Due to limited hospital resources, many centres that perform PCI have adopted
protocols where STEMI patients are transferred to a non-PCI capable centre following
successful PCI. However, the safety of this practice is not well established. The
study objective is to evaluate the clinical outcomes of the current practice of transferring
patients to non-PCI capable centres following successful PCI in a single, tertiary
care regional PCI centre.
METHODS AND RESULTS
A retrospective analysis was performed of all consecutive STEMI patients presenting
to a single, regional cardiac care centre between January 2013 and December 2014.
STEMI patients with high-risk features including cardiac arrest, cardiogenic shock,
medical complication nof STEMI, requiring transvenous pacing, mechanical ventiliation,
mechanical circulatory support or not reperfused by PCI were excluded. Patients who
were unable to be linked to the Provincial Population Registry were also excluded.
Patients were analyzed based on whether they were transferred to a non-PCI capable
centre following PCI for ongoing post-STEMI care. Clinical presentation, comorbidities,
angiographic findings, revascularization, and repatriation status data were collected
from the electronic medical record and cath lab database. Study data was linked to
the Research Repository at the Manitoba Centre for Health Policy for long-term clinical
outcomes. Of the 1092 consecutive STEMI patients screened, 337 patients (31%) were
excluded (Figure). The final study cohort (n=697) included 397 repatriated patients
and 300 non-repatriated patients. The median age of the study cohort was 60 (53-70)
years. Baseline characteristics are summarized in the Table. The median length of
stay at the PCI-capable hospital was 139 minutes (IQR 97-235 minutes) with 84% of
patients transferred within 6 hours. Inverse probability of treatment weighting (IPTW)
was used to adjust for unbalanced characteristics between the two study groups. All-cause
mortality (12.9% admitted vs 10.4% repatriated patients, adjusted HR 0.90, 95% CI
0.64-1.26, p=0.535) and repeat MI (11.0% admitted vs 5.4% repatriated, adjusted HR
0.71, 95% CI 0.49-1.02, p=0.06) at 5 years were not statistically significant after
IPTW adjustment, respectively.
This analysis demonstrated that there is no increased risk of mortality or repeat
MI at five years in STEMI patients who are transferred to a non-PCI capable centre
following successful PCI. This suggests that early repatriation is safe and effective
for low-risk STEMI patients.