Hospitals performing primary PCI on >75% of STEMI patients had a 30-day all-cause mortality rate of 2.7% compared to 5.0% in hospitals performing it on >25% of patients.
Observational (n=8,653)
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Does higher hospital volume and proportion of primary PCI improve door-to-balloon times and 30-day mortality in STEMI patients?
Higher hospital volume and a greater proportion of STEMI patients undergoing primary PCI are significantly associated with shorter door-to-balloon times and lower 30-day mortality.
Tasa de eventos absoluta: 2.7% vs 5%
AIMS: To quantify the determinants of primary percutaneous coronary intervention (PCI) performance in England and Wales between 2004 and 2007. METHODS AND RESULTS: All 8653 primary PCI cases admitted to acute hospitals in England and Wales as recorded in the Myocardial Ischaemia National Audit Project (MINAP) 2004-2007. We studied the impact of the volume of primary PCI cases (hospital volume) on door-to-balloon (DTB) times and the proportion of patients treated with primary PCI (hospital proportion) on 30-day mortality and employed regression analysis to identify reasons for DTB time variations with a multilevel component to express hospital variation. The proportion of patients receiving primary PCI increased from 5% in 2004 to 20% in 2007. Median DTB times reduced from 84 min in 2004 to 61 min in 2007. Median DTB times decreased as the number of primary PCI procedures increased. The 30-day all-cause mortality rate for hospitals performing primary PCI on >25% of ST-elevation myocardial infarction patients 5.0%; 95% confidence interval (CI): 3.9-6.1% was almost double that of hospitals performing primary PCI on more than 75% (2.7%; 95% CI: 2.0-3.5%). Time-of-day, year of admission, sex, and diabetes significantly influenced DTB times. Hospital variation was evident by a hospital-level DTB time standard deviation of 12 min. CONCLUSIONS: There was a large variation in DTB times between the best and worst performing hospitals. Although patient-related factors impacted upon DTB times, the volume and proportion of patients undergoing primary PCI were significantly associated with delay and early mortality-hospitals with the highest proportion of primary PCI had the lowest mortality.
West et al. (Fri,) conducted a observational in ST-elevation myocardial infarction (n=8,653). High hospital proportion of primary PCI (>75% of STEMI patients) vs. Low hospital proportion of primary PCI (>25% of STEMI patients) was evaluated on 30-day all-cause mortality. Hospitals performing primary PCI on >75% of STEMI patients had a 30-day all-cause mortality rate of 2.7% compared to 5.0% in hospitals performing it on >25% of patients.