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

• Published in: Canadian journal of cardiology 2015-10, Vol.31 (10), p.1225-1231
• Main Authors: Abuzeid, Wael, MD, Bennell, Maria, MSc, MPH, Qiu, Feng, MSc, Kassam, Saleem, MD, FRCPC, Overgaard, Chris, MD, FRCPC, Fam, Neil, MD, FRCPC, Wijeysundera, Harindra C., MD, PhD, FRCPC
• Format: Article
• Language: English
• Subjects: Canada - epidemiology; Cardiology Service, Hospital - statistics & numerical data; Cardiovascular; Female; Humans; Male; Middle Aged; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Outcome Assessment (Health Care); Patient Readmission - statistics & numerical data; Patient Transfer - methods; Patient Transfer - statistics & numerical data; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - methods; Propensity Score; Risk Assessment; Risk Factors; Survival Analysis; Time Factors
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/j.cjca.2015.01.039

Abstract Background 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. Methods 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. Results 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). Conclusions 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.