Long-term mortality in patients with STEMI transported primary or secondary to the cardiac center and treated by primary PCI.

Background: The purpose of this study was to compare long-term outcomes of primary transport (PT) and secondary transport (ST) in patients with STEMI. Method: We assigned consecutive 869 patients referred for STEMI during a 2-year period (2008-2009). The primary endpoint was to compare long-term outcomes and mortality of PT to a catheterization laboratory and ST from regional hospitals to a catheterization laboratory. Six hundred seventy-seven patients (77.9%) were enrolled for the final evaluation, 192 (22.1%) having been excluded. Results: The median DBT was 34 +/- 15.92 min for PT patients (n = 354) and 100 +/- 28.82 min for ST patients (n = 323) (P < 0.005). One-month mortality was 3.95% in the PT group versus 9.46% in the ST group (P = 0.002). One-year mortality in the PT was 7.35% and 20.51% in the ST group (P < 0.005). Eight-year mortality was in the PS 26.8% versus 32.6% in the ST group (P = 0.035). Left ventricular ejection fraction (LVEF) was 45 +/- 12.14% versus 45 +/- 12.48% (P = 0.21); creatine kinase (CK) was 22.78 +/- 78.69 ukat/L versus 23.21 +/- 82.61 ukat/L, (P = 0.58); and length of hospitalization was 4.98 +/- 4.61 days in the PT group versus 5.25 +/- 5.86 days in the ST group (P = 0.22). The air transport was used in the PT group (RR 0.85, 95% CI 0.63-1.09); and ST group (RR 1.17, 95% CI 0.91-1.40); P = 0.22). Time distribution of cardiac arrest median for PT 1432 days (n = 25) versus ST 266 (n = 31) P = 0.24. Conclusion: The mortality benefits of PT to a PCI capable hospital persist throughout an 8-year follow-up.