Assessing the Safety of Early Repatriation for Stable ST-Segment Elevation Myocardial Infarction Patients After Primary Percutaneous Coronary Intervention

Background: Repatriation of ST-segment elevation myocardial infarction (STEMI) patients after primary percutaneous coronary intervention (PPCI) is common in regional health care programs. We examined the short- and long-term safety of early repatriation after PPCI in stable STEMI patients. Methods: Consecutive stable STEMI patients undergoing PPCI between 2016 to 2018 in the Fraser Health Authority were included. Outcomes were compared between early and nonrepatriated cohorts. Co-primary outcomes were a composite of death, myocardial infarction, congestive heart failure, and stroke at 30 days and 1 year. Logistic regression analyses were performed to determine association between early repatriation and outcomes, and to assess impact of transfer to cardiologist- vs internist-based care centres. Results: A total of 788 patients were included, with 62% being repatriated early. Primary composite and individual outcomes rates were similar between both cohorts. Early repatriation was not an independent predictor of 30-day (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.50-1.72; P = 0.82) or 1-year (OR 1.05, 95% CI 0.67-1.65; P = 0.8) primary outcome, or of 30-day (OR 1.35, 95% CI 0.41-4.47, P = 0.63) or 1-year (OR 1.03, 95% CI 0.44-2.40; P = 0.95) mortality. Among early repatriated patients, transfer to cardiologist- vs internist-based care centres was not an independent factor for 30-day (OR 1.07, 95% CI 0.45-2.54; P = 0.87) or 1-year (OR 1.17, 95% 0.55-2.50, P = 0.69) primary outcome. Conclusions: Early repatriation of stable STEMI patients after PPCI appears to be safe based on short- and long-term outcomes, and transfer to internist- vs cardiology-based centres did not affect outcomes. After PPCI, early repatriation allows for redistribution of stable STEMI patients to lower-acuity settings across regional hospitals.