Interhospital transfer versus direct admission for percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction: a systematic review and meta-analysis.
Clinical Research in Cardiology · 2025-12-15 · Meta-analysis
Abstract
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.
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Tags
Interfacility & critical care transport · Mortality & survival · Time intervals
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