Delayed Transfer to a PCI-Capable Hospital for STEMI Leads to Higher Mortality

In-hospital mortality more than doubled when time spent at a referral hospital was >30 minutes.

Approximately 75% of U.S. hospitals do not have percutaneous coronary intervention (PCI) capability, and prolonged door-in to door-out (DIDO) time at the referral hospital delays reperfusion and worsens outcome. In a retrospective cohort study, researchers evaluated the effect of DIDO time on outcome in 14,821 patients with ST-segment-elevation myocardial infarction (STEMI) who were transferred to 298 U.S. centers for primary PCI between 2007 and 2010.

Median DIDO time was 68 minutes. DIDO times were within the recommended 30 minutes for only 11% of patients and exceeded 90 minutes in 35%. In-hospital mortality was significantly higher in patients with DIDO times >30 minutes than in those with times ≤30 minutes (5.9% vs. 2.7%). Factors signi…

Reviewing Authors

John A. Marx, MD, FAAEM

Ron M. Walls, MD, FRCPC, FAAEM

Disclosures

Speaker's bureauAirway Management Education Center, LLC

EquityAirway Management Education Center, LLC

Grant / Research supportAgency for Health Care Research and Quality

Editorial boardsManual of Emergency Airway Management; Rosen's Emergency Medicine; UpToDate; Scientific American Medicine