Direct transfer to primary percutaneous coronary intervention centres following out-of-hospital cardiac arrest: longer term outcomes and influences on survival

OBJECTIVE: Myocardial infarction is a leading cause of out-of-hospital cardiac arrest (OHCA). In patients with OHCA due to suspected acute coronary occlusion, direct transfer to a centre capable of primary percutaneous coronary intervention (PPCI) has been shown to improve short-term outcomes. However, practice remains heterogeneous and the impact on longer-term survival is unclear. We evaluated whether direct transfer of OHCA patients with ST-elevation was associated with improved short-term, medium-term and long-term survival compared with indirect transfer via a non-PPCI hospital. METHODS: This retrospective cohort study collected data from a national myocardial infarction registry within a regional emergency service network. Adults with OHCA, return of spontaneous circulation and ST-elevation on post-arrest ECG were included between April 2015 and September 2022. Patients were categorised according to direct transfer to a PPCI centre or indirect transfer via a non-PPCI hospital. The primary outcome was all-cause mortality at 3 years, with landmark analyses at 30 days and 1 year. Survival was analysed using adjusted FPSMs, with covariates including age, sex, witnessed event, presenting rhythm and time to emergency response. RESULTS: 613 patients were included; 359 (59%) were transferred directly and 254 (41%) indirectly. Call-to-balloon time was shorter following direct transfer (134 min vs 222 min) and survival to discharge was higher (81% vs 68%). Following adjustment, indirect transfer was associated with higher mortality at 30 days (adjusted HR 2.48, 95% CI 1.08 to 5.73), with excess risk attenuating thereafter and stabilising after approximately 6 months. Cumulative incidence of death at 3 years was 27.9% versus 41.3%, an absolute risk difference of 13.5%. CONCLUSION: In patients with OHCA and ST-elevation, direct transfer to PPCI centres was associated with improved survival up to 3 years. This advantage appears driven predominantly by early in-hospital outcomes, supporting direct triage for rapid reperfusion and optimised post-resuscitation care.