020 Transfer Time is not a major determinant of in-hospital mortality in Primary PCI when performed in a well organized urban network

AimIn STEMI, controversial data exist on the relative importance of patient-dependent time (Symptom-Onset (SO) to first medical contact (FMC)) and Transfer Time (TT=time from FMC to sheath insertion). We assessed the impact of TT on in-hospital (IH) mortality in a well organized urban network using Mobile Intensive Care Units (MICU).MethodsIn a web-based registry (e-PARIS), we evaluated delay in care of 705 consecutive STEMI patients transferred to the Pitié-Salpêtrière cath-lab for primary PCI.ResultsPopulation was 63±14 y/o, 75.6% were male, 46.9% had anterior MI, 16.7% were in Killip class 2, and 3.8% had out-of-hospital cardiac arrest. Abciximab was used in 82.4%, radial approach in 87.7% and stenting in 89.7% of patients. Median time (IQR) from SO to FMC was 110 (248) min (102 (190) min when FMC was MICU and 160 (381) min when FMC was a referring hospital, p<0.0001). Median TT was 104 (75) min (95 (45) min for MICU and 151 (178)min for patients transferred from a primary hospital, p<0.0001). When divided into quartiles, increasing TT was associated with higher IH mortality. This relation to IH mortality was striking in patients presenting early (within 2 hours of SO), and not significant in late presenters (>2 hours of SO) (fig). After adjustment for baseline characteristics, TT was not associated with mortality anymore suggesting that the sicker patients had the longest TT.ConclusionsThe association between TT and early mortality is strongly dependent on patients’ characteristics and time to presentation. After adjustment for these parameters, TT does not appear to be a major contributor of IH mortality in a well organized urban network for primary PCI. Improving time-to-first medical contact may be more critical