February 14, 2005
Time of the Essence When Transferring Heart Attack Patients
(Philadelphia, PA) – In an editorial in the February
15th issue of Circulation, Howard C.
Herrmann, MD, Director of Interventional Cardiology
& the Cardiac Catheterization Laboratory at the
Hospital of the University of Pennsylvania,
notes time is a critical factor in determining the risk/benefit
to heart-attack patients when transferring them to a
hospital that can perform angioplasty (surgical repair
of a blood vessel). Indeed, should these patients, who
present with acute ST-elevation myocardial infraction
(STEMI), be routinely transferred from hospitals without
a catheterization lab to facilities equipped with one
to perform immediate angioplasty rather than receive
medical therapy at the initial hospital?
Several recent trials have concluded that angioplasty
is better than fibrinolysis (the process of breaking
up and dissolving blood clots using medications) in
treating acute STEMI patients, and that even with an
added transfer time to another hospital, it still retains
However, in this issue of Circulation, a 2005
study (Nallamothu et al.) evaluated transfer times of
more than 4,200 patients and found that there was an
average delay time of 180 minutes from the time a patient
presented at a hospital to the time they underwent angioplasty
after transfer to another facility capable of immediate
angioplasty, also know as door-to-balloon time. This
is double the recommended amount of time – 90
minutes – from presentation to catheterization,
according to American College of Cardiology/American
Heart Association guidelines.
“These time delays are dramatic and could mean
the difference between life and death for some of these
patients,” says Dr. Herrmann. “That’s
why it is too early to recommend routine transfers for
primary angioplasties for all patients presenting with
STEMI, until protocols are put in place to ensure rapid
Dr. Herrmann suggests putting into place common practices
already performed in some European countries and in
isolated areas in the U.S. These practices include:
better identifying those patients who would benefit
most from transfer, optimizing communication systems
to include early mobilization of the cardiac catheterization
team in the transfer hospital, minimizing delays on
arrival at the transfer hospitals to the catheterization
laboratory, and possibly creating specialized centers
utilizing the latest advanced therapies.
“Although the rapid performance of angioplasty
may be the best treatment for most patients with acute
MI, delays in its application may make alternatives,
including thrombolysis, a better choice for some patients,”
adds Dr. Herrmann.
a printer friendly version of this release,
Editor’s Notes: Dr. Herrmann
is available for interviews on this position.
The University of Pennsylvania has an on-campus
television studio with satellite uplink, live-shot capability
for interviews with Penn experts.
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