February 1, 2009European Journal of Cardiovascular Prevention & Rehabilitation

Outcome of patients with acute myocardial infarction admitted in hospitals with or without catheterization laboratory: results from the HELIOS registry

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Why the study?

Does admission to a hospital with a catheterization laboratory improve in-hospital outcomes in patients with acute myocardial infarction?

Structured PICO

Does admission to a hospital with a catheterization laboratory improve in-hospital outcomes in patients with acute myocardial infarction?

Population

1,840 patients with acute myocardial infarction from 31 hospitals in Greece (Hellenic Infarction Observation Study)

Intervention

Admission to a hospital with a catheterization laboratory

Comparator

Admission to a hospital without a catheterization laboratory

Outcome

In-hospital mortalityhard clinical

Admission to hospitals without catheterization laboratories does not confer a survival disadvantage for acute myocardial infarction patients, provided they receive appropriate lytic therapy and guideline-directed care.

Implication

Admission without cath lab not associated with higher AMI mortality; leaves open optimal transfer strategies in unselected cohorts.

Abstract

AIMS: To compare the treatment and outcomes of myocardial infarction patients in hospitals with and without catheterization laboratory. METHODS AND RESULTS: The Hellenic Infarction Observation Study was a countrywide registry of acute myocardial infarction, conducted during 2005-2006. The registry enrolled 1840 patients with myocardial infarction from 31 hospitals with a proportional representation of all types of hospitals and of all geographical areas. Out of these patients, 645 (35%) were admitted in 11 hospitals with and 1195 (65%) in 20 hospitals without catheterization laboratory. Patients admitted in hospitals with catheterization laboratory in comparison with patients admitted in hospitals without were younger (66+/-14 vs. 68+/-13, P<0.004) with less diabetes (27 vs. 33%, P<0.001), but without other baseline differences (female 27 vs. 25%, prior myocardial infarction 20 vs. 17%, Killip class>1 22 vs. 23%). Reperfusion rates for ST-segment elevation myocardial infarction were 67% (43% lytic, 24% primary percutaneous coronary interventions) versus 56% (55% lytic, 1% percutaneous coronary interventions; P<0.01). In-hospital outcomes in hospitals with versus in hospitals without laboratory were: mortality 6.5 versus 8.3% (NS), stroke 2.2 versus 1.1% (NS), major bleeding 1.1 versus 0.6% (NS), and heart failure 11 versus 16% (P<0.01). In multivariate regression analysis, being admitted in a hospital without catheterization laboratory was not an independent predictor of increased in-hospital mortality (odds ratio=1.18, 95% confidence interval: 0.72-1.93, P=0.505). CONCLUSION: Although the majority of acute myocardial infarction patients was admitted in hospitals without catheterization laboratory, these patients do not have a survival disadvantage, provided they are treated with lytic therapy, medical secondary prevention drugs, and eventual revascularization according to current guidelines.