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. 2022 Mar 11:9:793067.
doi: 10.3389/fcvm.2022.793067. eCollection 2022.

Indirect Transfer to Catheterization Laboratory for ST Elevation Myocardial Infarction Is Associated With Mortality Independent of System Delays: Insights From the France-PCI Registry

Farzin Beygui  1 , Vincent Roule  1 , Fabrice Ivanes  2 , Thierry Dechery  3 , Olivier Bizeau  4 , Laurent Roussel  5 , Philippe Dequenne  6 , Marc-Antoine Arnould  7 , Nicolas Combaret  8 , Jean Philippe Collet  9 , Philippe Commeau  10 , Guillaume Cayla  11 , Gilles Montalescot  9 , Hakim Benamer  12 , Pascal Motreff  8 , Denis Angoulvant  2 , Pierre Marcollet  3 , Stephan Chassaing  7 , Katrien Blanchart  1 , René Koning  13 , Grégoire Rangé  5
Affiliations

Indirect Transfer to Catheterization Laboratory for ST Elevation Myocardial Infarction Is Associated With Mortality Independent of System Delays: Insights From the France-PCI Registry

Farzin Beygui et al. Front Cardiovasc Med. .

Abstract

Background: First medical contact (FMC)-to-balloon time is associated with outcome of ST-elevation myocardial infarction (STEMI). We assessed the impact on mortality and the determinants of indirect vs. direct transfer to the cardiac catheterization laboratory (CCL).

Methods: We analyzed data from 2,206 STEMI patients consecutively included in a prospective multiregional percutaneous coronary intervention (PCI) registry. The primary endpoint was 1-year mortality. The impact of indirect admission to CCL on mortality was assessed using Cox models adjusted on FMC-to-balloon time and covariables unequally distributed between groups. A multivariable logistic regression model assessed determinants of indirect transfer.

Results: A total of 359 (16.3%) and 1847 (83.7%) were indirectly and directly admitted for PCI. Indirect admission was associated with higher risk features, different FMCs and suboptimal pre-PCI antithrombotic therapy.At 1-year follow-up, 51 (14.6%) and 137 (7.7%) were dead in the indirect and direct admission groups, respectively (adjusted-HR 1.73; 95% CI 1.22-2.45). The association of indirect admission with mortality was independent of pre-FMC and FMC characteristics. Older age, paramedics- and private physician-FMCs were independent determinants of indirect admission (adjusted-HRs 1.02 per year, 95% CI 1.003-1.03; 5.94, 95% CI 5.94 3.89-9.01; 3.41; 95% CI 1.86-6.2, respectively).

Conclusions: Our study showed that, indirect admission to PCI for STEMI is associated with 1-year mortality independent of FMC to balloon time and should be considered as an indicator of quality of care. Indirect admission is associated with higher-risk features and suboptimal antithrombotic therapy. Older age, paramedics-FMC and self-presentation to a private physician were independently associated with indirect admission. Our study, supports population education especially targeting elderly, more adequately dispatched FMC and improved pre-CCL management.

Keywords: Pre-hospital; ST-elevation myocardial infarction; mortality; percutaneous coronary intervention; system delays.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart and details of first medical contact to cardiac catheterization laboratory pathways. Direct admission to catheterization laboratory appears in bold text. STEMI, ST elevation myocardial infarction; PCI, percutaneous coronary intervention; EMS, emergency medical services; ED, emergency department; MD, medical doctor; ICU, intensive care unit; Cath lab, catheterization laboratory.
Figure 2
Figure 2
Kaplan-Meier curves for survival (A) and cardiovascular survival (B) based on direct or indirect admission to catheterization laboratory.
Figure 3
Figure 3
In-hospital and 1-year mortality rates based on different pathways to catheterization laboratory. PCI, percutaneous coronary intervention; EMS, emergency medical services; ED, emergency department; MD, medical doctor; H, hospital.
See this image and copyright information in PMC

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