Impact of Transfer for Primary Percutaneous Coronary Intervention on Survival and Clinical Outcomes (from the HORIZONS-AMI Trial)

Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy m patients with ST-segment elevation myocardial infarction (STEMI) We evaluated whether presentation of patients with STEMI to a noninterventional facility requiring transfer for primary PCI compared to direct admission to a PCI center has an impact on clinical outcomes Of 3,602 patients enrolled in the multicenter, prospective HORIZONS-AMI trial, 988 (24 7%) were transferred for primary PCI and 2,614 were directly admitted to an interventional hospital Clinical outcomes at 30 days and 1 year were evaluated Median time to reperfusion in patients with transfer was 67 minutes longer compared to patients without transfer (272 vs 205 minutes, p <0 001), and first door-to-balloon time was 47 minutes longer (134 vs 87 minutes, p <0 001) At 30 days and 1 year there were no significant differences between patients with and without transfer in the rates of major adverse cardiac events (30 days 5 8% vs 5 4%, p = 0 68, 1 year 11 6% vs 12 0%, p = 0 74), major bleeding (30 days 7 3% vs 69%, p = 0 66, 1 year 7 9% vs 7 4%, p = 0 63), or mortality (30 days 2 6% vs 2 6%, p = 0 92, 1 year 4 0% vs 4 2%, p = 0 81) In transfer and nontransfer patients use of bivalirudin compared to unfractionated heparin plus glycoprotein IIb/IIIa inhibitor was associated with lower rates of bleeding, cardiac death, and net adverse clinical events In conclusion, in the HORIZONS-AMI trial, 30-day and 1-year survival rates and clinical outcomes were comparable in patients with STEMI requiring and not requiring transfer for primary PCI (C) 2010 Elsevier Inc All rights reserved (Am J Cardiol 2010, 106 1218-1224)