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TOPLINE
Among patients with out-of-hospital cardiac arrest (OHCA), direct transfer to a primary percutaneous coronary intervention (PPCI) center was associated with lower 3-year mortality than indirect transfer through a non-PPCI hospital. The survival benefit was observed during the first 30 days after cardiac arrest.
METHODOLOGY
- Researchers conducted an observational study using data from a major clinical audit and national registry in the UK to evaluate whether direct transfer to a PPCI center vs indirect transfer through a non-PPCI hospital was associated with improved survival after OHCA.
- They included 613 patients who experienced OHCA and subsequent return of spontaneous circulation with Northwest Ambulance Service, with evidence of active or transient ST elevation myocardial infarction on the pre-hospital ECG between April 2015 and September 2022.
- Patients were either transferred directly to a PPCI center (n = 359) or underwent indirect transfer through a non-PPCI hospital (n = 254). Mean age in both the groups was 61 years, and 81% and 78% patients, respectively, were men.
- The primary clinical endpoint was all-cause mortality at 3 years.
TAKEAWAY
- At 3 years, the cumulative incidence of mortality was lower in the direct transfer group than in the indirect transfer group (27.9 vs 41.3), yielding an absolute risk difference of 13.5% (95% CI, 5.9%-21%).
- In landmark analyses, the cumulative incidence of mortality during the first 30 days was lower in the direct transfer group than in the indirect transfer group (20.3 vs 32.3), representing an absolute risk difference of 12.0% (95% CI, 4.8%-19%).
- After adjustment, indirect transfer was associated with the highest risk for mortality at 30 days (adjusted hazard ratio [aHR], 2.48; 95% CI, 1.08-5.73). The risk then declined and stabilized after approximately 6 months but remained elevated at 1 year (aHR, 1.67; 95% CI, 1.03-2.72) and 3 years (aHR, 1.63; 95% CI, 1.06-2.53).
- The median call-to-balloon time was shorter with direct transfer than with indirect transfer (134 minutes vs 222 minutes). Across the cohort, odds of 30-day mortality increased progressively with each consecutive call-to-balloon time category compared with the reference category up to 120 minutes.
IN PRACTICE
"[The] findings support ongoing efforts to optimise regional pathways for OHCA management, while recognising the need for careful patient selection and further prospective evaluation," the researchers wrote.
SOURCE
The study was led by Alexander Hunt, Manchester Heart Centre, Manchester Royal Infirmary, Manchester, England. It was published online on September 7 in Heart.
LIMITATIONS
Residual confounding may have influenced the findings due to the observational nature of the analysis. Immortal time bias may have affected comparisons between direct and indirect transfer pathways. The relatively small sample size and declining number of patients during follow-up may have limited statistical power, particularly for later landmark intervals.
DISCLOSURES
The authors did not declare any specific grant for the study from any funding agency in the public, commercial, or not-for-profit sectors. The authors did not declare any competing interests.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
