Direct transfer to primary percutaneous coronary intervention centres following out-of-hospital cardiac arrest: longer term outcomes and influences on survival
In brief
Direct transfer to PCI centre cuts 3-year death risk by 13%
Among 613 out-of-hospital cardiac arrest patients with ST-elevation, those taken straight to a primary PCI hospital had a 13.5% lower three-year mortality (27.9% vs 41.3%) and higher discharge survival (81% vs 68%). The benefit was strongest early, with the excess risk of indirect transfer disappearing after about six months, underscoring the value of rapid reperfusion triage.
- Journal
- Heart (British Cardiac Society) (Q1)
- Published
- 7 September 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Alexander Hunt, Steven Scholfield, Joseph Morris, Nicholas Lim, Adam Darnley, Justin Chiong, et al.
- PMID
- 42705903
- DOI
- 10.1136/heartjnl-2026-328408
Why clinicians should know about it
- Picked for Emergency Medicine (paper of the day, 8 September 2026): Direct transfer to PPCI improves OHCA survival
Abstract
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.