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Background <p>Primary PCI is the standard of care for STEMI, but whether interhospital transfer (IHT) to a PCI-capable center worsens outcomes versus direct admission (DA) is uncertain.</p> Methods <p>We systematically searched PubMed, EMBASE, Scopus, and Web of Science for comparative studies of IHT vs DA among STEMI patients undergoing primary PCI. The primary outcome was in-hospital mortality; secondary outcomes included 30-day, 6-month, and 12-month mortality, major adverse cardiovascular events (MACE), stroke, bleeding, target-vessel revascularization (TVR), heart-failure hospitalization, left-ventricular ejection fraction (LVEF), and reperfusion time metrics. A random effects model was used when heterogeneity was significant (I<sup>2</sup> &gt; 50%).</p> Results <p>Sixteen cohort studies (n = 183,422; 10 retrospective, 6 prospective) were included. In-hospital mortality was lower with IHT (RR 0.82, 95% CI 0.71–0.94), whereas 6-month mortality favored DA (RR 1.34, 95% CI 1.25–1.43). MACE, stroke, bleeding, TVR, heart-failure hospitalization, and 30-day/12-month mortality did not differ significantly. LVEF was modestly lower with IHT (MD − 1.79%, 95% CI − 3.33 to − 0.24). DA shortened symptom-to-admission (MD ≈103&#xa0;min), symptom-to-PCI (MD&#xa0;≈94&#xa0;min), and total ischemic time (MD&#xa0;≈70&#xa0;min). Although transferred patients achieved a shorter in-hospital D2B (MD ≈ − 8.4&#xa0;min) and were more likely to meet the &lt; 90-min benchmark (RR 1.08), these gains were outweighed by longer pre-PCI delays.&#xa0;After weighting on covariates, in-hospital&#xa0;mortality was essentially identical between groups.&#xa0;Time-dependent Cox regression similarly showed that LVEF differences were driven by clinical severity (Killip class) rather than transfer itself.</p> Conclusions <p>In current STEMI networks, IHT was not associated with consistently worse clinical outcomes than DA despite longer pre-PCI delays. Apparent early survival advantages for IHT and small LVEF decrements likely reflect timing patterns and selection/survivor bias. Minimizing prehospital delays remains essential.</p> Graphical Abstract <p></p>

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Interhospital transfer versus direct admission for percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2025年12月15日

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  • Anwar Zahran,
  • Fathi Milhem,
  • Mohammad Bdair,
  • Saja Amer,
  • Mohamed Rifai,
  • Firas Besharieh,
  • Orabi Hajjeh,
  • Mohammedsadeq A. Shweliya,
  • Nadeem Khayat,
  • Khadeeja Ali Hamzah,
  • Abdalhakim Shubietah

摘要

Background

Primary PCI is the standard of care for STEMI, but whether interhospital transfer (IHT) to a PCI-capable center worsens outcomes versus direct admission (DA) is uncertain.

Methods

We systematically searched PubMed, EMBASE, Scopus, and Web of Science for comparative studies of IHT vs DA among STEMI patients undergoing primary PCI. The primary outcome was in-hospital mortality; secondary outcomes included 30-day, 6-month, and 12-month mortality, major adverse cardiovascular events (MACE), stroke, bleeding, target-vessel revascularization (TVR), heart-failure hospitalization, left-ventricular ejection fraction (LVEF), and reperfusion time metrics. A random effects model was used when heterogeneity was significant (I2 > 50%).

Results

Sixteen cohort studies (n = 183,422; 10 retrospective, 6 prospective) were included. In-hospital mortality was lower with IHT (RR 0.82, 95% CI 0.71–0.94), whereas 6-month mortality favored DA (RR 1.34, 95% CI 1.25–1.43). MACE, stroke, bleeding, TVR, heart-failure hospitalization, and 30-day/12-month mortality did not differ significantly. LVEF was modestly lower with IHT (MD − 1.79%, 95% CI − 3.33 to − 0.24). DA shortened symptom-to-admission (MD ≈103 min), symptom-to-PCI (MD ≈94 min), and total ischemic time (MD ≈70 min). Although transferred patients achieved a shorter in-hospital D2B (MD ≈ − 8.4 min) and were more likely to meet the < 90-min benchmark (RR 1.08), these gains were outweighed by longer pre-PCI delays. After weighting on covariates, in-hospital mortality was essentially identical between groups. Time-dependent Cox regression similarly showed that LVEF differences were driven by clinical severity (Killip class) rather than transfer itself.

Conclusions

In current STEMI networks, IHT was not associated with consistently worse clinical outcomes than DA despite longer pre-PCI delays. Apparent early survival advantages for IHT and small LVEF decrements likely reflect timing patterns and selection/survivor bias. Minimizing prehospital delays remains essential.

Graphical Abstract