Direct transfer to primary percutaneous coronary intervention centres after out-of-hospital cardiac arrest: long-term survival outcomes
A Darnley, A Hunt, J Chiong, J Morris, N Lim, S Scholfield, F Fath OrdoubadiAbstract
Background
Myocardial infarction is a leading cause of out-of-hospital cardiac arrest (OHCA). In select patients with OHCA due to suspected acute coronary occlusion, direct transfer to a centre capable of primary percutaneous coronary intervention (PPCI) has been shown to improve short-term outcomes. However, practice remains heterogeneous, and the impact on longer-term survival is unclear.
Purpose
To evaluate whether direct transfer of OHCA patients with ST-elevation to a PPCI centre is associated with improved long-term survival compared with indirect transfer from hospitals without a PPCI service.
Methods
This retrospective cohort study collected data from a national myocardial infarction registry within a regional emergency service network. Adults with OHCA, return of spontaneous circulation and ST-elevation on post-arrest ECG were included between April 2015 and June 2022. Patients were categorised according to direct transfer to a PPCI centre or indirect transfer via a non-PPCI hospital. The primary outcome was survival at 30 days, 1 year and 3 years. Survival was analysed using adjusted flexible parametric survival models. Covariates included age, sex, witnessed event, presenting rhythm and time to emergency service response.
Results
A total of 702 patients were included; 415 (59%) were transferred directly and 287 (41%) indirectly. Call-to-balloon time was shorter following direct transfer (153 vs. 245 mins; p<0.001). Survival to discharge was higher in the direct group (79% vs. 68%, p<0.001). Following adjustment for covariates, direct transfer was associated with higher survival at 30 days (risk ratio 1.10, 95% confidence interval 1.07-1.13), 1 year (1.12, 1.09-1.16) and 3 years (1.14, 1.10-1.19).
Conclusions
In patients with OHCA and ST-elevation, direct transfer to PPCI centres was associated with improved survival up to three years. This survival advantage appears to be driven predominantly by early in-hospital outcomes, supporting direct triage to PPCI centres for rapid reperfusion and optimised post-resuscitation care.Baseline characteristics of patientsAdjusted flexible parametric survival curves