Mortality Risk in STEMI Patients Linked to Slow Transfers

Nearly 90% of patients with a severe type of heart attack called a "STEMI," who go to hospitals that lack catheterization capability, have a 56% higher risk of mortality when they aren't transferred to a suitable hospital within the recommended 30 minutes.

Additionally, if the patient doesn't leave the first hospital within 90 minutes, the risk of inhospital mortality doubles.

Those are conclusions from an analysis of outcomes for 14,821 patients with an ST Segment elevation myocardial infarction (STEMI) form of heart attack who went to one hospital first, but had to be transferred to receive a percutaneous intervention or PCI to unblock a coronary artery.

"A lot of our efforts have focused on inhospital process to facilitate reperfusion (of blocked arteries), or on door-to-balloon time," Tracy Wang, MD, of Duke University School of Medicine and the report's principal author said in a telephone interview.

"But we're trying to pay more and more attention to those patients who first come to a non-PCI hospital or a hospital that doesn't do round-the-clock PCI, to see how we can expedite the transfer of these patients" in order to provide life-saving care and avoid heart muscle damage," she said.

The study is published in today's Journal of the American Medical Association. It focuses on a relatively new term in heart care called the DIDO, a metric developed in 2008 by the American College of Cardiology/American Heart Association to indicate the time between the patient's entrance to the first hospital, or door in, to the time they left it for the hospital with the cath lab, or door out.