| Acute myocardial infarction is a major global cause of death. Early administration of reperfusion therapy improves survival in patients with ST-elevation myocardial infarction by reestablishing coronary blood flow within the occluded infarct-related artery.Reperfusion therapy including primary percutaneous coronary intervention (PCI) and thrombolytic therapy has become the most important strategy for the treatment of acute ST-segment elevation myocardial infraction (STEMI).According to a meta-analysis from 23 randomized trails comparing primary PCI with thrombolysis,primary PCI is more effective than thrombolytic therapy for acute STEMI in terms of reducing overall short-term mortality,non-fatal reinfarction,and hemorrhagic stroke.on the basis of these trails,primary PCI is widely regarded as the reperfusion strategy of choice in acute STEMI.Transfer to a hospital for primary PCI can result in greater utilization of the medical resources.More patients with STEMI would benefit from this approach.This can transfer the patients with STEMI in the hospital without a catheterization laboratory to another hospital for primary PCI.Objective To assess the feasibility of transfer for primary percutaneous coronary intervention(PCI) in patients with ST- segment elevated acute myocardial infaction. Methods Fifty-five cases in STEMI patients from September 2005 to March 2007 ,onset of symptoms≤12h.Divided into two groups , transfer group (25 cases) and thrombolytic therapy group (30 cases) . Compared baseline characteristics, treatments and time delays ,the rate of major adverse cardiovascular event (MACE in hospital, after 4 weeks and half an year ,respectively),left ventricular ejection fraction (LVEF,7- 10 days and 3 months after PCI),target vessel revascularization (TVR)and length of hospital stay.Results1,Baseline characteristics between the two groups were comparable.2,Treatments and time delays the distance of transfer group was 35～100 miles, the time 40～90min, no patient died or required cardiopulmonary resuscitation during transfer, and minor events during transfer were observed in only 2 patients ( with hypotension ). Patients transferred for PCI had the longest time to treatment (125min vs 31min).Among the transfer group, 100% had primary PCI, IRA 25 branchs,TIMI grade 0: 21, TIMI grade 1: 2,TIMI grade 2: 2, the reopen rate of infarct related artery (IRA) was 100% and 96% had normal flow (TIMI grade 3) established,1case (TIMI grade 2) ; 77% of patients were noted to have multivessel disease; and 96% received one or more stents. Among the thrombolytic therapy group, reopen cases was 19 , the reopen rate of infarct related artery (IRA) was 63.3%;and failed 11, death was due to ventricular fibrillation in 1, chose elective percutaneous coronary intervention 9 cases ,TIMI grade 0: 7 ,TIMI grade 1: 1,TIMI grade 2: 1.3,Patients transferred for primary PCI had a shorter length of hospital stay [(9.29±4.21)vs(17.21±9.89),p<0.05].4,Clinical outcomes MACE: in hospital(8% vs 40%,P=0.007), 4 weeks(12% vs 47%,P=0.006), half an year(16% vs 53%,P=0.004);LVEF 7- 10 days(51.6±2.12 vs 44.3±4.2,p<0.05),3 months(53.4±1.98 vs 45.2±5.6,p<0.05) ;TVR(4% vs 40%,P=0.002 ). In conclusion ,patients with acute ST elevation myocardial infarction transport for primary percutaneous coronary intervention is efficient.Conclusions1,The time from arrival to treatment was delayed in the transfer group,but have an improved short term prognosis versus on-site thrombolysis.2,Patients of the transfer group had an improved LVEF, a reduced hospital stay and less TVR.3,It's safe and feasible to transfer the AMI patient . Transfer for the primary PCI can save more myocardium , reduce the MACE in short term ,improve the prognosis.4,DES is safe and effect.
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