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Prospective multicenter randomized trial comparing physician versus patient transfer for primary percutaneous coronary intervention in acute ST-segment elevation myocardial infarction / 中华医学杂志(英文版)
Chinese Medical Journal ; (24): 485-491, 2008.
Artículo en Inglés | WPRIM | ID: wpr-287706
ABSTRACT
<p><b>BACKGROUND</b>Primary percutaneous coronary intervention (PCI) has been identified as the first therapeutic option for patients with acute ST-segment elevation myocardial infarction (STEMI). The strategy of transferring patient to a PCI center was recently recommended for those with acute STEMI who were present to PCI incapable hospitals, which include lack of facilities or experienced operators. In China, some local hospitals have been equipped with PCI facilities, but they have no interventional physicians qualified for performing primary PCI. This study was conducted to assess the feasibility, safety and efficacy of the strategy of transferring physician to a PCI-equipped hospital to perform primary PCI for patients with acute STEMI.</p><p><b>METHODS</b>Three hundred and thirty-four consecutive STEMI patients with symptom presentation = 12 hours in five local hospitals from November 2005 to November 2007 were randomized to receive primary PCI by either physician transfer (physician transfer group, n=165) or patient transfer (patient transfer group, n=169) strategy. Door-to-balloon time, in-hospital and 30-day major adverse cardiac events (MACE, including death, non-fatal re-infarction, and target vessel revascularization) were compared between the two groups.</p><p><b>RESULTS</b>Baseline characteristics between the two groups were comparable. Thrombolysis in myocardial infarction (TIMI) 3 flow was revealed in more patients in the physician transfer group at initial angiography (17.6% vs 10.1%, P<0.05). The success rate of primary PCI (96.3% vs 95.4%, P>0.05) and length of hospital stay were similar between the two groups ((15+/-4) days vs (14+/-3) days, P>0.05). In the physician transfer group, door-to-balloon time was significantly shortened ((95+/-20) minutes vs (147+/-29) minutes, P<0.0001) and more patients received primary PCI with door-to-balloon time less than 90 minutes (21.2% vs 7.7%, P<0.001). During hospitalization, MACE occurred in 6.7% and 11.2% of patients in the physician and patient transfer groups, respectively (P=0.14). At 30-day clinical follow-up, the occurrence rates of death, non-fatal re-infarction, and target vessel revascularization (TVR) were 3.6% vs 5.9%, 4.2% vs 8.9%, and 1.2% vs 2.4% in the physician and patient transfer groups, respectively (all P>0.05). The cumulative composite of MACE was significantly reduced (8.9% vs 17.2%, P=0.03) and MACE free survival (91.0% vs 82.9%, P<0.05) was significantly improved in the physician transfer group at 30 days.</p><p><b>CONCLUSION</b>The strategy of transferring physician to local hospital to perform primary PCI for patients with acute STEMI is feasible, safe and efficient in reducing the door-to-balloon time and 30-day MACE rate.</p>
Asunto(s)
Texto completo: Disponible Índice: WPRIM (Pacífico Occidental) Asunto principal: Grupo de Atención al Paciente / Terapéutica / Factores de Tiempo / Angioplastia Coronaria con Balón / Transferencia de Pacientes / Complejo GPIIb-IIIa de Glicoproteína Plaquetaria / Comunicación Interdisciplinaria / Sistemas de Comunicación en Hospital / Infarto del Miocardio Tipo de estudio: Ensayo Clínico Controlado / Estudio pronóstico Límite: Adulto / Anciano / Femenino / Humanos / Masculino Idioma: Inglés Revista: Chinese Medical Journal Año: 2008 Tipo del documento: Artículo

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Texto completo: Disponible Índice: WPRIM (Pacífico Occidental) Asunto principal: Grupo de Atención al Paciente / Terapéutica / Factores de Tiempo / Angioplastia Coronaria con Balón / Transferencia de Pacientes / Complejo GPIIb-IIIa de Glicoproteína Plaquetaria / Comunicación Interdisciplinaria / Sistemas de Comunicación en Hospital / Infarto del Miocardio Tipo de estudio: Ensayo Clínico Controlado / Estudio pronóstico Límite: Adulto / Anciano / Femenino / Humanos / Masculino Idioma: Inglés Revista: Chinese Medical Journal Año: 2008 Tipo del documento: Artículo