Background: The creation of a network to treat patients with acute coronary syndrome with revascularization devices presents a series of critical issues, one of which is the transfer of this type of patients from a spoke to a hub hospital with angioplasty facilities. We investigated the means of transport and the adverse events that could occur during such transfers.
Methods: We analyzed data relating to patients moved from our spoke hospital to hubs over a period of 2 years, utilizing medical records and transport reports.
Results: During this period, 531 patients aged 30-91 years were moved; complete clinical data and transfer reports were available for 495 (93%). There were 42 patients with a diagnosis of ST-elevation myocardial infarction (STEMI) <24 h; 115 with STEMI >24 h; 33 with non-ST-elevation myocardial infarction (NSTEMI) <24 h; 156 with NSTEMI >24 h; 122 with unstable angina; and 27 with other diseases. Of these patients, 157 had angina in the 24 h before the transfer; 24 had signs of hemodynamic instability; and 18 had electrical instability, for a total of 166 "unstable patients"; 294 patients (59%) were moved in a medically equipped ambulance with a cardiologist and a professional nurse on board. There were three adverse events (< 1%) but no deaths: one cardiac arrest, one acute pulmonary edema, and one relapse of myocardial infarction. All 3 patients showed signs of clinical and hemodynamic instability at the time of transfer.
Conclusions: The transfer from spoke to hub of patients with acute coronary syndrome who need coronary angiography can be done easily and safely, with a low incidence of adverse events, which are correlated with preexisting clinical and hemodynamic instability.