Division of Cardiology, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
EuroIntervention. 2009 Nov;5(5):599-603. doi: 10.4244/eijv5i5a96.
To describe the safety of immediate retransfer to community hospitals following primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI).
In a cohort of 246 consecutive patients transferred to a tertiary institution who all underwent primary or rescue PCI, 166 (67%) were immediately retransferred back. The retransfer occurred only if they were haemodynamically stable and had undergone an uncomplicated procedure. In-hospital adverse events were assessed in each referral hospital. Patients had a mean age of 59 years, presented an anterior MI in 39%, and 91% were in Killip class 1. In this cohort, 75% of patients underwent primary PCI and 25% received rescue PCI. A transradial approach was used in 74% of patients. During ambulance transport back to the referral hospital, no adverse events occurred. In-hospital outcomes were favourable, with low death (2.4%), reinfarction (3.6%) and stroke (1.2%) rates. TIMI major bleeding occurred in 1.8% (catheter-related in 0.6%).
In this carefully selected population of STEMI patients, immediate retransfer to the referral hospital following primary or rescue PCI is feasible in more than 2/3 of patients and associated with a low risk of major clinical adverse events.
描述直接转至社区医院在 ST 段抬高型心肌梗死（STEMI）患者行直接经皮冠状动脉介入治疗（PCI）后的安全性。
在一项连续 246 例转至三级机构的患者队列中，所有患者均接受了直接或补救性 PCI，其中 166 例（67%）立即转回。仅在血流动力学稳定且手术过程简单的情况下才会进行转院。在每个转诊医院评估住院期间的不良事件。患者的平均年龄为 59 岁，前壁心肌梗死占 39%，91%的患者为 Killip 1 级。在该队列中，75%的患者接受了直接 PCI，25%的患者接受了补救性 PCI。74%的患者采用经桡动脉入路。在救护车返回转诊医院的途中，未发生不良事件。住院期间的结局良好，死亡率（2.4%）、再梗死率（3.6%）和卒中率（1.2%）均较低。TIMI 大出血发生率为 1.8%（与导管相关的为 0.6%）。
在这项精心选择的 STEMI 患者人群中，直接转至转诊医院行直接或补救性 PCI 是可行的，超过 2/3的患者可进行直接转院，且主要临床不良事件的风险较低。
