One-Year Clinical Outcome of Interventionalist- Versus Patient-Transfer Strategies for Primary Percutaneous Coronary Intervention in Patients With Acute ST-Segment Elevation Myocardial Infarction Results From the REVERSE-STEMI Study

• Published in: Circulation Cardiovascular quality and outcomes Vol. 4; no. 3; pp. 355 - 362
• Main Authors: Zhang, Qi, Zhang, Rui Yan, Qiu, Jian Ping, Zhang, Jun Feng, Wang, Xiao Long, Jiang, Li, Liao, Min Lei, Zhang, Jian Sheng, Hu, Jian, Yang, Zheng Kun, Shen, Wei Feng
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.05.2011
• Subjects: Aged; Angioplasty, Balloon, Coronary; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular system; China; Coronary heart disease; Diseases of the cardiovascular system; Electrocardiography; Female; Follow-Up Studies; Heart; Hospital-Physician Relations; Humans; Investigative techniques of hemodynamics; Investigative techniques, diagnostic techniques (general aspects); Longitudinal Studies; Male; Medical sciences; Middle Aged; Myocardial Infarction - mortality; Myocardial Infarction - physiopathology; Myocardial Infarction - therapy; Outcome Assessment (Health Care); Patient Transfer; Professional Practice; Proportional Hazards Models; Prospective Studies; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Retrospective Studies; Stroke Volume - physiology; Survival Rate; Technology Transfer; Time Factors; Treatment Outcome; China; Myocardial infarction; Prognosis; Angiography; Angioplasty; stents; Cardiovascular disease; Myocardial disease; Stent; Result; Percutaneous route; ST elevation; Randomization; Reperfusion; outcome and process assessment; Primary; Hospital; WHO; Human; Atherectomy; Radiodiagnosis; Acute; Coronary artery; Instrumentation therapy; Patient; Method; Coronary heart disease; Symptomatology; Sounding balloon; Total; Transfer; Strategy; End; Hemodynamics; Technique; Emergency; Comparative study; Fibrinolytic
• ISSN: 1941-7713; 1941-7705
• DOI: 10.1161/CIRCOUTCOMES.110.958785

Traditional reperfusion options for patients with acute ST-segment elevation myocardial infarction (STEMI) presenting to non-primary percutaneous coronary intervention (PPCI)-capable hospitals generally include onsite fibrinolytics or emergency transfer for PPCI. A third option, involving interventionalist transfer, was examined in the REVERSE-STEMI study. A total of 334 patients with acute STEMI who presented to 5 referral hospitals with angiographic facilities but without interventionalists qualified for PPCI were randomized to receive PPCI with either an interventionalist- (n=165) or a patient-transfer (n=169) strategy. The primary end point of door-to-balloon (D2B) time and secondary end points of left ventricular ejection fraction and major adverse cardiac events (MACE) at 1-year clinical follow-up were compared between the 2 groups. Compared with the patient-transfer strategy, the interventionalist-transfer strategy resulted in a significantly shortened D2B time (median, 92 minutes versus 141 minutes; P<0.0001), with more patients having first balloon angioplasty within 90 minutes (21.2% versus 7.7%, P<0.001). This treatment strategy also was associated with higher left ventricular ejection fraction (0.60±0.07 versus 0.57±0.09, P<0.001) and improved 1-year MACE-free survival (84.8% versus 74.6%, P=0.019). Multivariate Cox proportional hazards modeling revealed that the interventionalist-transfer strategy was an independent factor for reduced risk of composite MACE (hazard ratio, 0.63; 95% CI, 0.45 to 0.88; P=0.003). The interventionalist-transfer strategy for PPCI may be effective in improving the care of patients with STEMI presenting to a non-PPCI-capable hospital, particularly in a congested cosmopolitan region where patient transfers could be prolonged.