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

Background—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. Methods and Results—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 interventionalisttransfer 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). Conclusions—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. Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT00713557. (Circ Cardiovasc Qual Outcomes. 2011;4:355-362.)