ABC | Volume 112, Nº4, April 2019

Original Article Comparative Analysis between Transferred and Self-Referred STEMI Patients Undergoing Primary Angioplasty Maurício Balk , Henrique Basso Gome s, A lexandre Schaan de Quadros , Marco Aurélio Lumertz Saffi , Tiago Luiz Luz Leiri a Instituto de Cardiologia - Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, RS – Brazil Mailing Address: Tiago Luiz Luz Leiria • Av. Princesa Isabel, 370. Postal Code 90620-000, Santana, Porto Alegre, RS – Brazil E-mail: pesquisa.leiria@gmail.com, editoracao-pc@cardiologia.org.br Manuscript received May 18, 2018, revised manuscript July 29, 2018, accepted August 02, 2018 DOI: 10.5935/abc.20190014 Abstract Background: Studies have shown the benefits of rapid reperfusion therapy in acute myocardial infarction. However, there are still delays during transport of patients to primary angioplasty. Objective: To evaluate whether there is a difference in total ischemic time between patients transferred from other hospitals compared to self‑referred patients in our institution. Methods: Historical cohort study including patients with acute myocardial infarction treated between April 2014 and September 2015. Patients were divided into transferred patients (group A) and self-referred patients (group B). Clinical characteristics of the patients were obtained from our electronic database and the transfer time was estimated based on the time the e-mail requesting patient’s transference was received by the emergency department. Results: The sample included 621 patients, 215 in group A and 406 in group B. Population characteristics were similar in both groups. Time from symptom onset to arrival at the emergency department was significantly longer in group A (385 minutes vs. 307 minutes for group B, p < 0.001) with a transfer delay of 147 minutes. There was a significant relationship between the travel distance and increased transport time (R = 0.55, p < 0.001). However, no difference in mortality was found between the groups. Conclusion: In patients transferred from other cities for treatment of infarction, transfer time was longer than that recommended, especially in longer travel distances. (Arq Bras Cardiol. 2019; 112(4):402-407) Keywords: ST Elevation Myocardial Infarction/complications; Angioplasty, Balloon, Coronary/methods; Myocardial Reperfusion/methods; Fibrinolytic Agents; Intensive Care Units. Introduction For patients presented within 12 hours of ST-segment elevation acute myocardial infarction (STEMI), reperfusion therapy with thrombolytic agent or percutaneous transluminal coronary angioplasty (PTCA) should be provided as early as possible. 1 A shorter time-to-treatment in infarcted patients is associated with greater myocardial salvage and has a positive effect on ventricular function and mortality. 2,3 PTCA is the therapy of choice for coronary reperfusion, if initiated within 90 minutes from AMI diagnosis or 120 minutes for patients referred for PTCA at another center. 4,5 Nevertheless, some factors contribute to increasing time‑to‑treatment: a) unawareness of AMI-related signs and symptoms by the patients; b) unawareness of the benefits of a rapid reperfusion therapy; c) lack of healthcare facilities adequately equipped to early detect patients with STEMI; d) delay in defining the most appropriate reperfusion therapy and patient transportation delay. 6 For example, in hospitals for less complex cases, PTCA is not available, and the use of thrombolytic therapy or the transfer of patients to more specialized hospitals cause a delay in AMI treatment. In many countries, an integrated care system for STEMI is already available. 7 Strategies aimed at reducing the time to STEMI diagnosis and treatment are needed. However, data on inter-hospital transfer of patients in Brazil are scarce. The present study aimed at determining whether there are differences in total ischemic time between patients referred from other hospitals and those who self-referred, based on current guidelines’ recommendations. 8-10 Methods Study design This was a historical cohort study. Characteristics of inter-hospital transfer of patients The normal procedure for accepting a patient’s transfer for treatment of STEMI involves the receipt of an electrocardiography report (ECG) confirming the diagnosis of STEMI (previously by fax, and recently by e-mail). This would avoid costs in the health system with incorrect diagnosis and unnecessary referral to the emergency department. 402