PS. Hansen*, Y. Koyama, G. Rudan, J. Sharp, H. Rasmussen and G. Nelson.

Department of Cardiology, Royal North Shore Hospital, St Leonards, NSW.

District (D) and rural (R) hospital patients (pts) with acute myocardial infarction (MI) in whom fibrinolytic therapy (FT) fails or is contraindicated (C/I) have a high in-hospital morbidity and mortality with medical management.  Limited information is available on immediate transfer to a tertiary centre for urgent coronary angiography (CA)/intervention as an alternative.

Between 7/1997-1/2000 we prospectively examined in-hospital outcomes of 108 consecutive MI pts from D/R hospitals with FT failure (75%) or C/I (25%) ungently transferred to Royal North Shore Hospital (RNS) for immediate CA/intervention.  Pt arrival was "out of hours" in 66%.  Mean age was 63±13 yrs (range: 28-88 yrs) and F:M ratio 4:9.  Previous MI, PTCA, CABG, CVA and diabetes was present in 18%, 6%, 8%, 8% and 15% respectively and 30% of pts were Killip class III/IV at the time of transfer.  Mean time from diagnostic ECG to RNS notification and from RNS notification to pt arrival was 294 and 115 min respectively.  At CA 75% had TIMI 0, 1 or 2 flow in the infarct related artery.  TIMI 3 flow was established in 88% at a mean of 61 min after RNS arrival.  Treatment included: stenting 63%, PTCA 9%, emergency CABG ± MVR ± VSD/free wall repair 10%, in-hospital CABG 8% and no intervention 10%.  Reopro was used in 33% and IABP in 27%.  In-hospital mortality was 8.3% with reMI, CVA and TLR in 1.7%, 2.5% and 8.3% respectively.  Mean total D/R+RNS hospital stay was 8.3±8.8 days and 69% of patients were discharged directly to home from RNS.

In conclusion: Urgent transfer of MI patients from D/R hospitals with FT failure or C/I for immediate CA ± revascularisation results in a favourable short-term outcome considering the very high-risk nature of such patients.

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