Management of acute coronary syndrome and the importance of hospital access: Findings from the EPICOR Asia study

Objectives: To describe real-world inter-hospital transfer patterns for ACS patients in Asia in terms of surgical facilities. Background: Little is known about acute coronary syndromes (ACS) management and inter-hospital transfer, and any role of on- or off-site catheterization laboratory (cath lab) facilities in Asia. Results: EPICOR Asia (NCT01361386) is a prospective, multi-country, observational, cohort study of 12,922 ACS patients surviving to hospital discharge (51.2% ST-segment elevation myocardial infarction [STEMI], and 48.8% non-STEMI-ACS [19.9% non-NSTEMI, 28.9% unstable angina]). Patients were enrolled in Asia (218 hospitals/eight countries and regions) between June 2011 and May 2012 and categorized as non-transferred or transferred (latter includes patients transferred-in from another hospital and discharged, or transferred-out to a second hospital but discharged from their initial hospital after transfer back). Results: Most (82.9%) ACS patients were non-transferred, 16.9% were transferred-in and 0.2% transferred-out. Admission hospitals for most patients non-transferred (97.6%) had cath lab facilities while most transferred patients (83.5%) were initially admitted to a hospital without cath lab facilities and transferred to a hospital with facilities. The most frequent reasons for transfer were need for primary percutaneous coronary intervention (PCI) in STEMI, elective/routine PCI, and more advanced care, irrespective of diagnosis. Median times from symptom-onset to catheterization were consistently longer for patients who were transferred versus those who were not. Conclusions: In Asia, lack of either on-site cath lab facilities or need for more advanced care are frequent reasons for inter-hospital transfer in ACS. Follow-up of such patients will help evaluate if patterns of transfer affect outcomes.