Outcomes of Transfer Destination in Patients With STEMI: Enhanced Community Hospital vs Quaternary Medical Center.

BACKGROUND: The optimal transfer destination for patients with ST-segment elevation myocardial infarction presenting to nonpercutaneous coronary intervention (PCI)-capable hospitals remains unclear, particularly where both enhanced community (EC) hospitals with PCI capability and quaternary centers are available. PROJECT RATIONALE: Guidelines emphasize timely reperfusion but provide limited evidence on whether outcomes differ by hospital tier once PCI capability is ensured. PROJECT SUMMARY: Retrospective before-after quality improvement noninferiority analysis of 54 consecutive patients (EC n = 22, quaternary centers n = 32) presenting to a non-PCI-capable community hospital, comparing first door-to-balloon times, need for subsequent transfer, and major adverse cardiac events. Transfer to EC demonstrated noninferior (P < 0.0001) and significantly shorter door-to-balloon times (90.8 ± 15.5 vs 101.6 ± 18.9 min; P = 0.03) with equivalent major adverse cardiac events. TAKE-HOME MESSAGE: Transferring patients with ST-segment elevation myocardial infarction to a nearby EC PCI-capable hospitals enables faster reperfusion while maintaining quality and safety of care.