According to a large observational study presented at Acute Cardiovascular Care 2019 (2–4 March, Malaga, Spain), myocardial infarction patients taken directly to heart centres for lifesaving treatment have better long-term survival than those transferred from another hospital. Directly admitted patients were older, suggesting that heart attacks in young adults, and particularly women, go unrecognised by paramedics and patients.
The study compared characteristics, time to primary percutaneous coronary intervention (PCI), and long-term outcomes of ST-segment elevation myocardial infarction (STEMI) patients taken directly to a primary PCI hospital versus those transferred from another hospital. Patients with STEMI were treated with primary PCI between 2005 and 2015 at the eight primary PCI centres in London (UK). Patient details were recorded at the time of the procedure in the British Cardiovascular Intervention Society dataset. Data on all-cause mortality were obtained from the Office for National Statistics.
A total of 17,580 (69%) patients were admitted directly to primary PCI centres and 7,735 (31%) were transferred from other hospitals. The time between call for help and first hospital admission was similar between the two groups. However, the median time from call for help to opening the blocked artery with primary PCI was 52 minutes longer in transferred patients compared to those admitted directly.
After a median follow-up of three years, patients admitted directly to a primary PCI centre were significantly less likely to have died than those transferred from another hospital (17.4% vs,18.7%). After adjusting for factors that could influence the risk of death including age, previous heart attack and diabetes, direct admission to a primary PCI hospital was associated with a 20% lower risk of all-cause death.
Study author Krishnaraj Rathod (Barts Health NHS Trust, London, UK), says: “Our findings indicate that the superior survival in patients admitted directly to a primary PCI hospital was because there was a shorter gap between calling for help and receiving treatment. All patients with STEMI should be admitted directly to a primary PCI centre within 90 minutes of diagnosis by ECG, which is done by ambulance teams. Yet in our study nearly one-third were taken to another hospital first, indicating that a STEMI diagnosis was not made until patients reached that hospital, and they then had to be transferred. However, it must be noted that the rates of transfer directly to a primary PCI centre were better in the later years suggesting better identification of appropriate patients by healthcare staff.”
Furthermore, the study showed that the average of the cohort was younger than seen previously. “The age of first heart attacks is getting younger, one of the reasons is because of lifestyle habits. The average age in our cohort is no longer 60, but around 40 years and we even see patients in their 30s. Directly admitted patients were sicker but they were also older, indicating that paramedics may think heart attack is unlikely in younger adults. My message to them is ‘in cases of doubt, repeat the 12 lead ECG and consider speaking to the heart attack centre,” Rathod comments.