Effect of transfer delay on left ventricular function after primary PCI for ST elevation myocardial infarction

Abstract

Background: Primary PCI (PPCI) is superior to thrombolysis for treatment of acute ST Elevation Myocardial Infarction (STEMI). However, transfer to a PCI centre results in a treatment delay compared to those presenting directly to such hospitals. The aim of this study was to investigate the influence of transfer delay on LV function and clinical outcomes in PPCI patients. Methods: Of 113 consecutive PPCI patients, 69 presented directly to the PCI centre and 44 were transferred. Echocardiography was performed at day 1 and after 6 weeks to assess LV function using the Wall Motion Score Index (WMSI). Patients were followed for a mean of 3.51 years. Results: There was no significant difference in WMSI at day 1 between local and transfer patients (1.52 ± 0.36 and 1.48 ± 0.34 respectively, p=ns). After 6 weeks the WMSI improved significantly in both groups (1.33 ± 0.33 and 1.31 ± 0.31 respectively, p< 0.001 for both). On multivariate analysis, pain to balloon time. > 160. min, LAD stenosis and initial TIMI flow 0-1 were significant independent predictors of LV dysfunction. There was no significant difference in clinical events during long term follow up. Conclusions: Patients transferred for PPCI had similar LV function and clinical outcomes compared to those who presented directly to a PCI hospital.