Circ: Sending interventionalists to STEMI patients can improve outcomes

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In Shanghai, China, a highly-populated and traffic-congested city, STEMI patients saw better long-term results and received faster treatment when an “interventionalist-transfer strategy” was used, according to the results of the REVERSE-STEMI study published in the April 26 issue of Circulation: Cardiovascular Quality and Outcomes.

Qi Zhang, MD, of the Ruijin Hospital in Shanghai, China, and colleagues enrolled 334 STEMI patients into the study. All patients were initially brought to one of five hospitals in Shanghai that had cardiac catheterization labs but not specialists who could perform primary percutaneous coronary infusion (PPCI) or primary PCI.

Almost half of the patients in the study were transferred to a sixth hospital capable of performing PPCI (169 patients). The others were treated with the interventionalist-transfer strategy, in which patients stayed at the hospitals where their condition was diagnosed and an interventional cardiologist from the PPCI-capable hospital was dispatched to the patient (165 patients).

For patients in the interventionalist-transfer group, interventionalists in a tertiary hospital were on standby 24/7 and could go directly to the local hospital housing the patient by taxi or automobile once they received the call.

The researchers reported door-to-balloon (D2B) times for the period between the STEMI patient’s arrival to the hospital and when a balloon was inflated. The researches reported that 21.2 percent of the patients in the inteventionalist-transfer group had PPCI performed within the 90-minute time frame vs. 7.7 percent of those in the patient-transfer group. Patients in the interventionalist-transfer arm saw significantly shorter D2B times compared to the patient-transfer arm, 92 minutes vs. 141 minutes.

At one year, the researchers reported that 84.8 percent of patients whose specialist was dispatched to the hospital had survived and were free of major adverse cardiac events compared with 74.6 percent of the patient transfer group.

Left ventricular ejection fractions (LVEFs) for patients in the interventionists-transfer group were higher than the patient-transfer group.

The researchers noted that traffic increased the D2B times of patients being transferred to PPCI-capable hospitals. The average transfer distance was almost 11 miles, and the researchers reported that the risk of cardiac complications also increased during the transfer period.

“The interventionalist-transfer strategy could be an important tool in metropolitan areas of China or elsewhere if resources such as ambulances and emergency staff are in short supply, leading to delays in transferring patients," the researchers wrote. “Until emergency infrastructure in some cities can be improved, we believe this strategy is a good interim option,” Zhang said.

The researchers concluded that an improved ambulance network with direct field triage for STEMI patients and an automated system to transmit ECGs or instructions to the paramedics could improve outcomes and lead to a more rapid patient trasfer that would also shorten D2B times.