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Infarct size in primary angioplasty without on-site cardiac surgical backup versus transferal to a tertiary center: a single photon emission computed tomography study

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Abstract

Background

Primary percutaneous coronary intervention (PCI) performed in large community hospitals without cardiac surgery back-up facilities (off-site) reduces door-to-balloon time compared with emergency transferal to tertiary interventional centers (on-site). The present study was performed to explore whether off-site PCI for acute myocardial infarction results in reduced infarct size.

Methods and results

One hundred twenty-eight patients with acute ST-segment elevation myocardial infarction were randomly assigned to undergo primary PCI at the off-site center (n = 68) or to transferal to an on-site center (n = 60). Three days after PCI, 99mTc-sestamibi SPECT was performed to estimate infarct size. Off-site PCI significantly reduced door-to-balloon time compared with on-site PCI (94 ± 54 versus 125 ± 59 min, respectively, p < 0.01), although symptoms-to-treatment time was only insignificantly reduced (257 ± 211 versus 286 ± 146 min, respectively, p = 0.39). Infarct size was comparable between treatment centers (16 ± 15 versus 14 ± 12%, respectively p = 0.35). Multivariate analysis revealed that TIMI 0/1 flow grade at initial coronary angiography (OR 3.125, 95% CI 1.17–8.33, p = 0.023), anterior wall localization of the myocardial infarction (OR 3.44, 95% CI 1.38–8.55, p < 0.01), and development of pathological Q-waves (OR 5.07, 95% CI 2.10–12.25, p < 0.01) were independent predictors of an infarct size > 12%.

Conclusions

Off-site PCI reduces door-to-balloon time compared with transferal to a remote on-site interventional center but does not reduce infarct size. Instead, pre-PCI TIMI 0/1 flow, anterior wall infarct localization, and development of Q-waves are more important predictors of infarct size.

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Authors and Affiliations

  1. Department of Cardiology, Medical Center Alkmaar, 1815 JD, Alkmaar, The Netherlands

    Maarten de Mulder, Hans O. Peels, Jan H. Cornel & Victor A. W. M. Umans

  2. Department of Nuclear Medicine, Medical Center Alkmaar, Alkmaar, The Netherlands

    Friso M. van der Zant

  3. Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands

    Paul Knaapen & Albert C. van Rossum

  4. Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands

    Jos W. R. Twisk

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  1. Paul Knaapen
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Correspondence to Victor A. W. M. Umans.

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Knaapen, P., de Mulder, M., van der Zant, F.M. et al. Infarct size in primary angioplasty without on-site cardiac surgical backup versus transferal to a tertiary center: a single photon emission computed tomography study. Eur J Nucl Med Mol Imaging 36, 237–243 (2009). https://doi.org/10.1007/s00259-008-0917-8

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