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STEMI mortality in community hospitals versus PCI-capable hospitals: results from a nationwide STEMI network
Marc J Claeys1, Peter R Sinnaeve, Carl Convens
1University Hospital Antwerp, Edegem, Belgium.
Insights
This study found that ST elevation myocardial infarction (STEMI) networks achieved comparable in-hospital mortality rates between community and PCI-capable hospitals. Participation in STEMI networks improved adherence to reperfusion guidelines over time.
Area of Science:
- Cardiology
- Health Services Research
Background:
- Existing ST elevation myocardial infarction (STEMI) networks primarily focus on percutaneous coronary intervention (PCI) times and outcomes.
- Real-world data on the management and outcomes of unselected STEMI populations within these networks are limited.
Purpose of the Study:
- To evaluate reperfusion strategies and in-hospital mortality in a nationwide STEMI network.
- To assess the effectiveness of STEMI networks in community and PCI-capable hospitals.
Main Methods:
- The study analyzed 8500 unselected STEMI patients across 47 community and 25 PCI-capable hospitals in Belgium.
- Propensity score analysis was used to adjust for baseline differences between patient groups.
- Reperfusion strategies (primary PCI vs. thrombolysis) and door-to-balloon times were compared.
Main Results:
- Primary PCI was predominantly used in PCI-capable hospitals (93%) compared to community hospitals (71%).
- Door-to-balloon times <120 min were achieved in 83% of community and 91% of PCI-capable hospitals.
- In-hospital mortality was similar: 7.0% in community hospitals vs. 6.7% in PCI-capable hospitals (adjusted OR 1.1).
- The rate of primary PCI in community hospitals increased from 60% to 80% between 2007-2008 and 2009-2010.
Conclusions:
- STEMI networks with high primary PCI utilization (>70%) demonstrate comparable in-hospital mortality between community and PCI-capable facilities.
- Network participation correlated with improved adherence to reperfusion guidelines over time.
Aims:
Reports examining local ST elevation myocardial infarction (STEMI) networks focused mainly on percutaneous coronary intervention (PCI)-related time issues and outcomes. To validate the concept of STEMI networks in a real-world context, more data are needed on management and outcome of an unselected community based STEMI population.
Methods And Results:
The current study evaluated reperfusion strategies and in-hospital mortality in 8500 unselected STEMI patients admitted to 47 community hospitals (n=3053) and 25 PCI-capable hospitals (n=5447) in the context of a nationwide STEMI network programme that started in 2007 in Belgium. The distance between the hub and spoke hospitals ranged from 2.2 to 47 km (median 15 km). A propensity score was used to adjust for differences in baseline characteristics. Reperfusion strategy was significantly different with a predominant use of primary PCI (pPCI) in PCI-capable hospitals (93%), compared to a mixed use of pPCI (71%) and thrombolysis (20%) in community hospitals. A door-to-balloon time <120 min was achieved in 83% of community hospitals and in 91% of PCI-capable hospitals (p<0.0001). In-hospital mortality was 7.0% in community hospitals versus 6.7% in PCI-capable hospitals with an adjusted odds ratio of 1.1 (95% confidence interval: 0.8-1.4). Between the periods 2007-2008 and 2009-2010, the pPCI rate in community hospitals increased from 60% to 80%, whereas the proportion of conservatively managed patients decreased from 11.1% to 7.9%.
Conclusion:
In a STEMI network with >70% use of pPCI, in-hospital mortality was comparable between community hospitals and PCI-capable hospitals. Participation in the STEMI network programme was associated with an increased adherence to reperfusion guidelines over time.
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