| ObjectiveThis study sought to compare the characteristic,30-day and 1-year survival of patients diagnosed with ST-segment elevation myocardial infarction(STEMI),whose symptom onset to in-hospital first medical contact(IHFMC)was between 3 to 6hours,who received either in-hospital thrombolysis(IHT)in the nearest county hospital or direct-transfer to a larger hospital in Henan province,China for primary percutaneous coronary intervention(PPCI).MethodsFrom January 2013 to January 2014,999 patients were identified as STEMI patients after screening from 6 county hospitals affiliated to Zhengzhou city.A total of 653 patients were excluded from the study as either symptom onset to IHFMC was within 3 hours or longer than 6 hours.In total,346 patients matched the hours between 3 to 6 hours and were included in the study,of whom 13 were excluded as 6patients had contraindications for IHT and 7 patients refused to receive neither IHT or transferred PPCI.A total of 333 STEMI cases were taken up for the analysis comprising 192 patients in the IHT group and 141 patients in the transferred PPCI group.Clinical data and characteristic were analyzed and compared.Time points were recorded and 30-day and 1-year survival was compared between the two groups and the underlying factors were studied.Results1.Though the patients in the inter-hospital transfer group tended to be older and more likely male with a past history of transient ischemic attack or stroke,the differences were not statistically significant.Similar patterns were observed in both the groups with regard to cardiovascular risk factors,diabetic status,cardiovascular history,territory of STEMI,and number of diseased vessels.2.Through there was different time delay in the whole process,no significant differences were observed between the two groups in the symptom-to-IHFMC time,diagnosis time and the total ischemic time.3.The all-cause mortality in the IHT group and inter-hospital transfer group with PPCI at 30 days were not significantly different.However,the mortality in the IHT group and inter-hospital transfer group with PPCI at 1 year showed a significant difference.4.Univariate analysis showed that cardiogenic shock and cardiac arrest requiring ventilatory support were the two strongest predictors for mortality in this population at both 30 days and 1 year.Importantly,prior TIA or stroke remained a significant factor associated with mortality at 30 days and at 1 year.Left ventricular ejection fraction(LVEF)<40%,anterior myocardial infarction,diabetes mellitus,prior history of myocardial infarction,high blood pressure and advanced-age were still an independent predictor for lower mortality at 30 days.Multivariate analysis revealed that history of TIA or stroke,pre-hospital arrest requiring ventilation,cardiogenic shock,LVEF above 0.40 and multivessel or left main diseases were associated with30-day and 1-year mortality.However,diabetes mellitus were associated with 30-day mortality but inter-hospital transfer for PPCI was associated with better survival with1-year.Also inter-hospital transfer time for PPCI tends to be the independent predictor for survival.Conclusion1.Althrough there was different degree of time delay of the whole process of with in-hospital thrombolysis,it is still a safe and effective reperfusion therapy forSTEMI patients with symptom on-set in 3-6 hours in primary hospital.2.Althrough the transfer time was above 2 hours,STEMI patients undergoing PPCI in inter-hospital transfer group had a higher overall survival rate compared with patients treated locally with IHT.3.Despite a longer time delay associated with inter-hospital transfer for PPCI,there was no difference in total ischemic time between the two groups and benefits for patients with STEMI between 3 and 6 hours after symptom onset offset the disadvantages of over 2 hours' transferred time delay. |
PDF Full Text Request