Outcome in transferred and nontransferred patients after primary percutaneous coronary intervention for ischaemic out-of-hospital cardiac arrest.

OBJECTIVE: To evaluate the impact of transfer from a referral hospital to a center with primary percutaneous coronary intervention (PCI) facilities of ST-segment elevation myocardial infarction (STEMI) patients after successful cardiopulmonary resuscitation (CPR).

METHODS: We studied all STEMI patients with successful CPR admitted to two centers after out-of-hospital cardiac arrest and CPR from January 2004 to December 2005. Subjects were divided in a transferred (PCI performed after referral from center without PCI facility) and nontransferred (PCI performed in hospital of admission, i.e. center with PCI facility) group.

RESULTS: A total of 44 patients were included. Mean age was 61 +/- 13 year and 35 (80%) patients were male. Of all patients 16 (36%) were transferred for treatment. After treatment, the left ventricular function was preserved in 4 (25%) patients of the transferred group are compared with 17 (61%) of the nontransferred group (P = 0.024). In-hospital mortality after follow-up did not differ with 7 (44%) survivors in the transferred group versus 15 (54%) survivors in the nontransferred group (P = 0.76). Patients who did not survive were more often treated with endotracheal intubation (100% versus 71%, P= 0.019), had more often an occlusion of the proximal right coronary artery (37% versus 10%, P= 0.02), and higher glucose levels at admission (15.2 mmol/l +/- 4.4 versus 11.5 mmol/l +/- 4.2, P= 0.009).

CONCLUSION: In conclusion, no difference in outcome was observed between nontransferred and transferred patients. Therefore, we suggest that transfer for primary PCI for STEMI patients after successful CPR should be considered.