Access to reperfusion therapy and mortality outcomes in patients with ST-segment elevation myocardial infarction
Chulaporn Limwattananon1, Jiraphan Jaratpatthararoj2, Jutatip Thungthong2
1Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Khon Kaen University, 123 Moo 16 Mitraphap Road, Muang District, Khon Kaen, 40002, Thailand. limw0002@kku.ac.th.
Insights
Access to percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) increased in Thailand, significantly reducing mortality. This demonstrates progress in providing advanced reperfusion therapies to a wider population.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Public Health Policy
Background:
- Limited data exists on reperfusion therapy access and mortality for ST-segment elevation myocardial infarction (STEMI) in developing nations.
- Thailand's universal health coverage, established in 2002, provides a unique context to study these trends.
Purpose of the Study:
- To analyze time trends in reperfusion therapy and mortality for STEMI patients in Thailand.
- To examine the geographical distribution of percutaneous coronary intervention (PCI) utilization.
- To assess the association between reperfusion therapy and mortality.
Main Methods:
- Time-series analysis of 69,031 STEMI hospitalizations (2011-2017) among Universal Coverage Scheme beneficiaries.
- Geospatial mapping of PCI-capable hospitals and PCI recipient distribution.
- Propensity-score matching and hospital-level panel data analysis to determine reperfusion-mortality association (PCI or thrombolysis vs. no reperfusion).
Main Results:
- PCI use increased by 5.7% annually, while thrombolysis-only use decreased by 2.2% annually.
- 30-day and 180-day mortality rates decreased among PCI recipients but increased among those receiving no reperfusion.
- PCI was associated with significantly lower 30-day (19.6%) and 180-day (21.1%) mortality compared to no reperfusion.
Conclusions:
- STEMI patients in Thailand experienced improved access to PCI, leading to reduced mortality.
- The findings indicate successful progress in delivering high-cost, effective healthcare interventions under universal coverage.
- Increased PCI utilization is linked to better patient outcomes, highlighting its importance in STEMI management.
Background:
Evidence on access to reperfusion therapy for patients with ST-segment elevation myocardial infarction (STEMI) and associated mortality in developing countries is scarce. This study determined time trends in the nationally aggregated reperfusion and mortality, examined distribution of percutaneous coronary intervention (PCI) utilization across provinces, and assessed the reperfusion-mortality association in Thailand that achieved universal health coverage in 2002.
Methods:
Data on hospitalization with STEMI in 2011-2017 of 69,031 Universal Coverage Scheme (UCS) beneficiaries were used for estimating changes in the national aggregates of % reperfusion and mortality by a time-series analysis. Geographic distribution of PCI-capable hospitals and PCI recipients was illustrated per provinces. The reperfusion-mortality association was determined using the propensity-score matching of individual patients and panel data analysis at the hospital level. The exposure is a presence of PCI or thrombolysis. Outcomes are all-cause mortality within 30 and 180 days after an index hospitalization.
Results:
In 2011-2017, the PCI recipients increased annually 5.7 percentage (%) points and thrombolysis-only recipients decreased 2.2% points. The 30-day and 180-day mortalities respectively decreased annually 0.20 and 0.27% points among the PCI recipients, and they increased 0.79 and 0.59% points among the patients receiving no reperfusion over the same period. Outside Bangkok, the provinces with more than half of the patients receiving PCI increased from 4 provinces of PCI-capable hospitals in 2011 to 37 provinces, which included the neighboring provinces of the PCI-capable hospitals in 2017. Patients undergoing reperfusion had lower 30-day and 180-day mortalities respectively by 19.6 and 21.1% points for PCI, and by 14.1 and 15.1% points for thrombolysis only as compared with no reperfusion. The use of PCI was associated with decreases in 30-day and 180-day mortalities similarly by 5.4-5.5% points as compared with thrombolysis only. A hospital with 1% higher in the recipients of PCI had lower mortalities within 30 and 180 days by approximately 0.21 and 0.20%, respectively.
Conclusions:
Patients with STEMI in Thailand experienced increasing PCI access and the use of PCI was associated with lower mortality compared with thrombolysis only. This is an evidence of progress toward a universal coverage of high-cost and effective health care.
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