Myocardial infarction patients have improved chances of long-term survival if they are sent directly to specialist centres, according to the findings of a major study of the effect of reorganisations in the UK.
The large observational UK-based study, which was presented at Acute Cardiovascular Care 2019, a European Society of Cardiology (ESC) congress, in Malaga, Spain, also found that younger patients – particularly women – were more likely to have their symptoms that went unrecognised by both themselves and paramedics.
Study author Dr Krishnaraj Rathod, of Barts Health NHS Trust, London, said: “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’.”
The study from the London Heart Attack Group included 25,315 patients with ST-elevation myocardial infarction (STEMI) and it compared characteristics, time to primary percutaneous coronary intervention (PCI), and long-term outcomes of STEMI patients taken directly to a primary PCI hospital compared with those who were transferred from another hospital.
The study found that 17,580 (69%) patients were admitted directly to primary PCI centres and 7,735 (31%) were transferred from other hospitals.
Although the time between call for help and first hospital admission was similar between the two groups, 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, the study team found that patients who went directly to a primary PCI centre were less likely to have died than those transferred from another hospital (17.4% versus 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.
Dr Rathod said: “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.”
Abstract: Inter-hospital transfer for primary PCI has worse outcome compared with direct admission to a heart attack centre: a study of 25,315 patients with STEMI from the London Heart Attack Group
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