Transfer of Patients with Acute Myocardial Infarction for Primary or Acute Angioplasty from Hospitals without the Facilities to Perform Angioplasty Results from the Pooled Data of the Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) Registry and the Myocardial Infarction Registry (MIR)

Abstract

In patients with acute myocardial infarction (AMI) admitted at hospitals without angioplasty facilities there are some subgroups of patients which seem to profit from a transfer to primary or acute angioplasty. However, current clinical practice at such hospitals is unknown. We analyzed the pooled data of the German acute myocardial infarction registries MITRA and the MIR. Angioplasty was not available at 221/271 hospitals (81.5%). Out of 14,487 patients with acute myocardial infarction admitted to these hospitals, 50.1% (7,259/14,487) received thrombolysis at the initial hospital and 3.6% (523/14,487) were transferred. Out of the transferred patients, 55.3% (289/523) were treated with primary angioplasty and 44.7% (234/523) received a combination of thrombolysis and angioplasty. The proportion of transferred patients increased from 1.1% in 1994 to 5.5% in 1998 (p for trend = 0.001). One hundred and four hospitals (47.1%) never transferred patients. Patients transferred for primary angioplasty (289 patients) were compared to patients treated with thrombolysis at the initial hospitals (7,259 patients). Multivariate analysis showed the following independent predictors for transfer of patients for primary angioplasty: contraindications for thrombolysis (OR = 17.9), a non-diagnostic first ECG (OR = 4.0), pre-hospital delay > 6 hours (OR = 2.5), unknown symptom onset of the acute myocardial infarction (OR = 2.0) and anterior wall acute myocardial infarction (OR = 1.6). Heart failure at admission was the only independent predictor not to transfer patients (OR = 0.40). In Germany only 47.1% of hospitals without angioplasty facilities transfer patients with acute myocardial infarction to primary or acute angioplasty. The proportion of transferred patients increased from 1.1% in 1994 to 5.5% in 1998. Contraindications for thrombolysis were the strongest predictor to transfer patients to primary angioplasty.

Clinical prognosis, pre-existing conditions and the use of reperfusion therapy for patients with ST segment elevation acute myocardial infarction

“…Likewise, in the Global Registry of Acute Coronary Events (39), only 70% of eligible STEMI patients received reperfusion therapy. While the use of primary angioplasty in our study was low when compared with international standards (40,41), the rates of primary angioplasty were comparable with other jurisdictions within Canada (19,42).…”

Declining Trend in the In-Hospital Case-Fatality Rate From Acute Myocardial Infarction in Miyagi Prefecture From 1980 to 1999.

“…Third, the difference in the in-hospital case-fatality rate was insignificant between patients who underwent primary PTCA and those who did not, if they were admitted or transferred 24 h or more after symptom onset. Many investigators have reported the advantages of current therapies, including primary PTCA, 2,7,22,23,26 and the in-hospital case-fatality rate of the present study was consistent with those reports (Fig 9).…”

Short-term Cost-effectiveness of Reteplase versus Primary Percutaneous Coronary Intervention in Patients with Acute STEMI a Tertiary Hospital in Iran

“…The two treatments have not significant differences in terms of complications. There are studies that have reported complications of PPCI are less than thrombolytic, but the number of patients in these studies was higher, and the mean age of the patients in therapy groups for these research is variable [8]. The mortality in both groups was 7.3% and entirely was close to credible other studies [9].…”