Clinical Outcomes of Early Repatriation for Patients With ST-Segment Elevation Myocardial Infarction: A Propensity-Matched Analysis

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• 作者：Wael Abuzeid ; MD^a ; Maria Bennell ; MSc ; MPH^b ; Feng Qiu ; MSc^c ; Saleem Kassam ; MD ; FRCPC^d ; Chris Overgaard ; MD ; FRCPC^e ; Neil Fam ; MD ; FRCPC^f ; Harindra C. Wijeysundera ; MD ; PhD ; FRCPC^a ; ^b ; ^c ; ^g ; ^{harindra.wijeysundera@sunnybrook.ca" class="auth_mail" title="E-mail the corresponding author}
• 刊名：Canadian Journal of Cardiology
• 出版年：2015
• 出版时间：October 2015
• 年：2015
• 卷：31
• 期：10
• 页码：1225-1231
• 全文大小：590 K

文摘

Because of limitations on hospital resources, patients with ST-elevation myocardial infarction (STEMI) who undergo successful primary percutaneous coronary intervention (PCI) are often repatriated to non-PCI centres. However, the safety of this practice is not clear. Our objective was to evaluate the safety of early repatriation of STEMI patients after PCI to a non-PCI centre, compared with ongoing treatment at the PCI centre.

absSec_2">Methods

abspara0015">Consecutive STEMI patients, who received primary PCI at 1 of 4 PCI hospitals in Toronto, Canada between 2010 and 2012 were identified. Patients with shock or who died within 24 hours of presentation were excluded. Outcomes of interest were all-cause mortality and readmission for recurrent myocardial infarction (MI) at 1 year. To account for confounding because of the observational nature of our data, propensity score-matched pairs of patients who were repatriated vs nonrepatriated were identified.

absSec_3">Results

abspara0020">Using the propensity score, 430 well matched pairs were identified, representing our cohort. There was no significant difference between repatriated and nonrepatriated groups in 1-year mortality (repatriated: 6.7%, nonrepatriated: 5.6%, hazard ratio, 1.18; 95% confidence interval, 0.69-2.03; P = 0.545). The 1-year readmission rates for MI were significantly greater for the repatriated group compared with the nonrepatriated group (repatriated: 12.1%; nonrepatriated: 5.8%; hazard ratio, 2.09; 95% confidence interval, 1.30-3.36; P = 0.002).

absSec_4">Conclusions

abspara0025">A strategy of early repatriation of STEMI patients was associated with a greater rate of readmission for MI. Our study raises questions regarding the safety of an early repatriation strategy that merit further research.