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Patients with acute myocardial infarction (AMI) may benefit from highly specialized services and interventions, most notably early coronary angiography and revascularization by percutaneous coronary intervention (PCI). These specialized services are not universally available among hospitals, and inter-hospital transfer is the primary means for accessing these services for many AMI patients. Although there is evidence that inter-hospital transfer for the treatment of AMI can reduce cardiac mortality for ST-elevation AMI, the long term benefit of this strategy is controversial, as well as whether this advantage extends to non-ST elevation acute AMI patients.
In order to address these questions, Ranasinghe and colleagues, (see page 1032) from the The George Institute in Sydney, conducted an investigation to assess whether hospitalized AMI patients who are transferred for specialized care during their AMI event have lower long-term mortality, compared to similar patients solely treated at the presenting hospital, evaluating the consistency of findings in transferred patients with different risk profile and among various population subgroups. The authors used a database of over 40 thousand patients with a diagnosis of AMI linked with the register of deaths of the State of New South Wales and matched transferred (25% of total) and non-transferred patients using propensity score matching, as well as performing several sensitivity analyses. They found that transferred patients were about 4 times more likely to undergo coronary revascularization and had lower long-term mortality, compared with patients treated solely at the presenting hospital. This survival advantage was observed in most subgroups analyzed, including non-ST elevation acute coronary syndrome patients (figure 1).
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