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Acute myocardial infarction and inter-hospital transfer
  1. Chris P Gale1,2,
  2. Marlous van Laar1,
  3. Christian Hamm3
  1. 1Division of Epidemiology and Biostatistics, University of Leeds, Leeds, UK
  2. 2York Teaching Hospital NHS Foundation Trust, UK
  3. 3Kerckhoff Heart and Thoraxcenter, Bad Nauheim Medical Clinic I, University of Giessen, Giessen, Germany
  1. Correspondence to Dr Chris P Gale, Division of Epidemiology and Biostatistics, University of Leeds, Leeds LS2 9JT, UK; c.p.gale{at}leeds.ac.uk

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Receipt of timely and specialised care for the management of acute myocardial infarction (AMI) is associated with improved clinical outcomes. Yet, not all hospitals are equipped and/or enabled to provide specialised interventions, and as a result patients may be transferred between centres to access these services. Given that there may be shortfalls in local capacity to deliver a high-quality cardiovascular service for AMI that may drive the necessity for centralisation of services, there is also a large body of evidence that suggests that inter-hospital transfer for the treatment of AMI, particularly primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI), is strongly associated with reduced mortality. Overall, the evidence suggests that higher volume and PCI-capable centres have lower mortality rates and that transfer of patients to such centres, through coordinated networks of care, is safe and effective. Such a notion is supported by international guidelines.1

One of the earliest reports of inter-hospital transfer for AMI studied 104 patients with suspected AMI, between 1983 and 1984, who were transferred by an aeromedical team. There were no deaths during transfer, and 87% of patients survived to be discharged from hospital.2 In 2000, the PRimary Angioplasty in patients transferred from General community hospitals to specialised PTCA Units with or without Emergency thrombolysis (PRAGUE) study found that of the 300 study participants presenting to hospital within 6 h of symptom onset with AMI, those who were randomised to immediate transportation for primary angioplasty without pretreatment with thrombolysis less frequently had the primary composite endpoint of death, reinfarction or stroke at 30 days.3 Notably, these findings were upheld at 5 years from date of randomisation.4 Other studies have investigated the impact of inter-hospital transfer across a range …

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