Interhospital transfer versus direct admission for percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction: A systematic review and meta-analysis

Authors

Anwar Zahran, Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, P.O. Box 7, Nablus, Palestine. anwarkzahran@gmail.com.
Fathi Milhem, Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, P.O. Box 7, Nablus, Palestine.
Mohammad Bdair, Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, P.O. Box 7, Nablus, Palestine.
Saja Amer, Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, P.O. Box 7, Nablus, Palestine.
Mohamed Rifai, Faculty of Medicine, Menoufia University, Menoufia, Egypt.
Firas Besharieh, Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, P.O. Box 7, Nablus, Palestine.
Orabi Hajjeh, Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, P.O. Box 7, Nablus, Palestine.
Mohammedsadeq A. Shweliya, University of Baghdad College of Medicine, Baghdad, Iraq.
Nadeem Khayat, Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, P.O. Box 7, Nablus, Palestine.
Khadeeja Ali Hamzah, Alkindy College of Medicine, Baghdad University, Baghdad, Iraq.
Abdalhakim Shubietah, Advocate Health - MidwestFollow

Recommended Citation

Zahran A, Milhem F, Bdair M, et al. Interhospital transfer versus direct admission for percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction: a systematic review and meta-analysis. Clin Res Cardiol. Published online December 15, 2025. doi:10.1007/s00392-025-02814-1

Affiliations

Advocate Illinois Masonic Medical Center

Abstract

Background: Primary PCI is the standard of care for STEMI, but whether interhospital transfer (IHT) to a PCI-capable center worsens outcomes versus direct admission (DA) is uncertain.

Methods: We systematically searched PubMed, EMBASE, Scopus, and Web of Science for comparative studies of IHT vs DA among STEMI patients undergoing primary PCI. The primary outcome was in-hospital mortality; secondary outcomes included 30-day, 6-month, and 12-month mortality, major adverse cardiovascular events (MACE), stroke, bleeding, target-vessel revascularization (TVR), heart-failure hospitalization, left-ventricular ejection fraction (LVEF), and reperfusion time metrics. A random effects model was used when heterogeneity was significant (I² > 50%).

Results: Sixteen cohort studies (n = 183,422; 10 retrospective, 6 prospective) were included. In-hospital mortality was lower with IHT (RR 0.82, 95% CI 0.71-0.94), whereas 6-month mortality favored DA (RR 1.34, 95% CI 1.25-1.43). MACE, stroke, bleeding, TVR, heart-failure hospitalization, and 30-day/12-month mortality did not differ significantly. LVEF was modestly lower with IHT (MD - 1.79%, 95% CI - 3.33 to - 0.24). DA shortened symptom-to-admission (MD ≈103 min), symptom-to-PCI (MD ≈94 min), and total ischemic time (MD ≈70 min). Although transferred patients achieved a shorter in-hospital D2B (MD ≈ - 8.4 min) and were more likely to meet the < 90-min benchmark (RR 1.08), these gains were outweighed by longer pre-PCI delays. After weighting on covariates, in-hospital mortality was essentially identical between groups. Time-dependent Cox regression similarly showed that LVEF differences were driven by clinical severity (Killip class) rather than transfer itself.

Conclusions: In current STEMI networks, IHT was not associated with consistently worse clinical outcomes than DA despite longer pre-PCI delays. Apparent early survival advantages for IHT and small LVEF decrements likely reflect timing patterns and selection/survivor bias. Minimizing prehospital delays remains essential.

Type

Article

PubMed ID

41396303