Transfer for reperfusion therapy in acute myocardial infarction

Background: Reperfusion therapy is highly recommended in ST-elevation myocardial infarction (STEMI) but its benefits are doubtful in cases that need transfer to another center. Objective: To analyze the outcomes in patients with STEMI transferred to another center for percutaneous coronary intervention (PCI). Methods: Patients with STEMI transferred for PCI were included from 2008 to 2014. We divided the sample in four zones: Zone 0 (Z0): Rosario; Zone 1 (Z1): up to 50 km distance; Zone 2 (Z2): between 50-200 km; Zone 3 (Z3): more than 200 km. In-hospital cardiac events were evaluated. Results: Three-hundred and seventy four patients were included in our study. Median time from onset symptoms to first medical contact was different between the zones (Z0: 2 h, Z1: 2.5 h, Z2: 6 h, Z3: 12 h; p< 0.05). The rate of global reperfusion therapy was 75.1%, but it decreased depending on the transferred zone (Z0: 79.2%; Z1: 77.1%; Z2: 67.1%; Z3: 47.1%; p< 0.05). From those who did not receive reperfusion, 11.8% arrived late and 9.9% did not present clinical criteria. Mean ejection fraction was 48.9 +/- 10.7% and a decrease was observed with the distance. In-hospital cardiac events were significantly higher according the distance (Z0: 8.9%; Z1: 14.6%; Z2: 19.2%; Z3: 23.5%; p< 0.05). Conclusion: We observed an association between the distance of transferred patients and the in-hospital outcomes.