Open AccessCardiac mortality benefit of direct admission to percutaneous coronary intervention–capable hospital in acute myocardial infarction
Author(s) -
Min Gyu Kang,
Yoomee Kang,
Kyehwan Kim,
Hyun Woong Park,
JinSin Koh,
Jeong Rang Park,
Seok-Jae Hwang,
Jae Young Ahn,
Yongwhi Park,
Yun-Mi Jeong,
Choong Hwan Kwak,
JinYong Hwang
Publication year - 2021
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000025058
Subject(s) - medicine , percutaneous coronary intervention , myocardial infarction , interquartile range , hazard ratio , conventional pci , cardiology , cumulative incidence , incidence (geometry) , confidence interval , revascularization , emergency medicine , cohort , physics , optics
Appropriate risk stratification and timely revascularization of acute myocardial infarction (AMI) are available in percutaneous coronary intervention (PCI) – capable hospitals (PCHs). This study evaluated whether direct admission vs inter-hospital transfer influences cardiac mortality in patients with AMI. This study was conducted in the PCH where the patients were able to arrive within an hour. The inclusion criteria were AMI with a symptom onset time within 24 hours and having undergone PCI within 24 hours after admission. The cumulative incidence of cardiac death after percutaneous coronary intervention was evaluated in the direct admission versus inter-hospital transfer groups. Among the 3178 patients, 2165 (68.1%) were admitted via inter-hospital transfer. Patients with ST-segment elevation myocardial infarction (STEMI) in the direct admission group had a reduced symptom onset-to-balloon time (121 minutes, P < .001). With a median period of 28.4 (interquartile range, 12.0–45.6) months, the cumulative incidence of 2-year cardiac death was lower in the direct admission group (NSTEMI, 9.0% vs 11.0%, P = .136; STEMI, 9.7% vs 13.7%, P = .040; AMI, 9.3% vs 12.3%, P = .014, respectively). After the adjustment for clinical variables, inter-hospital transfer was the determinant of cardiac death (hazard ratio, 1.59; 95% confidence interval, 1.08–2.33; P = .016). Direct PCH admission should be recommended for patients with suspected AMI and could be a target for reducing cardiac mortality.