{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T11:27:30Z","timestamp":1767180450230,"version":"build-2238731810"},"update-to":[{"DOI":"10.1371\/journal.pmed.1004679","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T00:00:00Z","timestamp":1753920000000}}],"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T00:00:00Z","timestamp":1753228800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Chinese Society of Cardiology Foundation","award":["CSCF2019A01"],"award-info":[{"award-number":["CSCF2019A01"]}]},{"name":"National Key Research and Development Project","award":["2022YFC2503500"],"award-info":[{"award-number":["2022YFC2503500"]}]},{"name":"National Key Research and Development Project","award":["2022YFC2503504"],"award-info":[{"award-number":["2022YFC2503504"]}]},{"name":"Jiangsu Hengrui Pharmaceuticals","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["www.plosmedicine.org"],"crossmark-restriction":false},"short-container-title":["PLoS Med"],"abstract":"\n Background<\/jats:title>\n Previous studies evaluating the influence of inter-hospital transfer on mortality in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) reported conflicting results. The multicenter BRIGHT-4 trial demonstrated that bivalirudin plus a post-PCI high-dose infusion (1.75\u00a0mg\/kg\/h) reduced the 30-day primary endpoint of all-cause mortality or Bleeding Academic Research Consortium (BARC) types 3\u20135 bleeding compared with heparin monotherapy in STEMI patients. This study aimed to assess the impact of inter-hospital transfer on clinical outcomes and the effectiveness of bivalirudin versus heparin in STEMI patients undergoing PCI.<\/jats:p>\n <\/jats:sec>\n \n Methods and findings<\/jats:title>\n \n In BRIGHT-4, 2,121 (35.7%) patients were transferred to a tertiary hospital for primary PCI while 3,817 (64.3%) were directly admitted to an interventional facility. The primary outcome was the composite of all-cause death or BARC types 3\u20135 bleeding occurring within 30 days. The secondary outcomes included stent thrombosis. Adjustments were made for baseline covariates and randomized treatments. Transferred patients had a longer median time from symptom onset to wire crossing the infarct-related artery (6.00 versus 3.93\u00a0hrs,\n \n P<\/jats:italic>\n <\/jats:italic>\n \u2009<\u20090.0001). At 30 days, there were no significant between-group differences in the rates of the primary outcome (4.2% versus 3.4%, adjusted hazard ratio [HR] 0.99, 95% confidence intervals [CI] 0.73, 1.33,\n \n P<\/jats:italic>\n <\/jats:italic>\n \u2009=\u20090.94) or its components. Bivalirudin with a high-dose post-PCI infusion was associated with consistent reductions of the primary outcome in the transfer (3.5% versus 4.8%, adjusted HR 0.66, 95%CI 0.42, 1.05) and direct admission (2.8% versus 4.1%, adjusted HR 0.62, 95% CI 0.43, 0.89) group compared with heparin monotherapy (\n \n P<\/jats:italic>\n <\/jats:italic>\n interaction<\/jats:sub>\n \u2009=\u20090.78), as well as individually for stent thrombosis. The main limitations of this study are that it is a\n \n post hoc<\/jats:italic>\n <\/jats:italic>\n analysis, and the long-term prognostic impact of transfer on STEMI patients requires further investigation.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n In this\n \n post hoc<\/jats:italic>\n <\/jats:italic>\n analysis, 30-day clinical outcomes for STEMI patients transferred for PCI were not significantly worse than direct admission patients. Bivalirudin with a post-PCI high-dose infusion for 2\u20134\u00a0hrs was associated with lower rates of 30-day all-cause mortality, major bleeding and stent thrombosis, consistently observed in transfer and direct admission patients.\n <\/jats:p>\n <\/jats:sec>\n \n Trial registration<\/jats:title>\n \n BRIGHT-4 trial\n NCT03822975<\/jats:ext-link>\n http:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pmed.1004679","type":"journal-article","created":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T17:45:34Z","timestamp":1753292734000},"page":"e1004679","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Analysis of inter-hospital transfer on clinical outcomes after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: A secondary analysis of the BRIGHT-4 trial"],"prefix":"10.1371","volume":"22","author":[{"given":"Xiaolin","family":"Su","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2077-5770","authenticated-orcid":true,"given":"Miaohan","family":"Qiu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chengqi","family":"Gu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiuhui","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7304-6806","authenticated-orcid":true,"given":"Bin","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fanbo","family":"Meng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bin","family":"Ning","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhixiong","family":"Zhong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhengzhong","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5316-2351","authenticated-orcid":true,"given":"Bei","family":"Shi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhuo","family":"Shang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhenyang","family":"Liang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1658-404X","authenticated-orcid":true,"given":"Yi","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4569-6737","authenticated-orcid":true,"given":"Yaling","family":"Han","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3416-8210","authenticated-orcid":true,"given":"Gregg 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