Key result
First admission to PCI hospitals for acute myocardial infarction was associated with lower 1-year mortality compared to non-PCI hospitals (24.5% vs. 34.7%; adjusted HR 0.66, 95% CI 0.48-0.90).
Why the study?
Does first admission to a PCI-capable hospital improve in-hospital and 1-year mortality in patients with acute myocardial infarction?
Cross-Sectional (n=687)
Yes
Does first admission to a PCI-capable hospital improve in-hospital and 1-year mortality in patients with acute myocardial infarction?
Hazard Ratio: 0.66 (95% CI 0.48–0.9)
Absolute Event Rate: 24.5% vs 34.7%
p-value: p=0.003
First admission to a PCI-capable hospital for acute myocardial infarction is associated with higher rates of evidence-based care and significantly lower in-hospital and 1-year mortality.
Should not yet change AMI triage; extends observational data but requires RCTs to confirm benefit.
OBJECTIVE: The objective of this study was to compare process of care, in-hospital outcomes, and 1-year mortality of patients with acute myocardial infarction (AMI) first admitted to hospitals with and without percutaneous coronary intervention (PCI) facilities in Estonia in 2007. METHODS: We conducted a retrospective cross-sectional study on a random sample of hospitalized AMI patients. Data on process of care and in-hospital outcomes were abstracted from patient records in 16 hospitals according to a standardized study form. RESULTS: Patients first admitted to PCI hospitals (n = 327) had higher rates of overall use of coronary angiography (78.3% vs. 24.7%; P < 0.001), revascularization (64.2% vs. 20.6%; P < 0.001), and echocardiography (85.3% vs. 65.3%, P < 0.001) than those first admitted to non-PCI hospitals (n = 360). Among the non-PCI hospital patients those selected for cardiac catheterization were younger, healthier, and had better clinical status on presentation. Patients admitted to PCI hospitals had higher prescription rates of in-hospital and discharge evidence-based medications except for beta-blockers. PCI hospitals' patients had lower in-hospital mortality (11.3% vs. 19.2%, P = 0.004) and 1-year mortality (24.5% vs. 34.7%, P = 0.003), results remained significant after adjustment for baseline characteristics (odds ratio 0.47; 95% confidence interval 0.28-0.78, hazard ratio 0.66; 95% confidence interval 0.48-0.90). CONCLUSIONS: There are disparities in process of care, in-hospital and 1-year mortality between patients first admitted to PCI vs. non-PCI hospitals in Estonia. Patients admitted to non-PCI hospitals should undergo more vigorous risk stratification using invasive and non-invasive methods; use of evidence-based medicine should be encouraged even if cardiac revascularization is not done.
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Blöndal et al. (2010) conducted a cross-sectional in Acute myocardial infarction (AMI) (n=687). First admission to PCI hospitals vs. First admission to non-PCI hospitals was evaluated on 1-year mortality (HR 0.66, 95% CI 0.48-0.90, p=0.003). First admission to PCI hospitals for acute myocardial infarction was associated with lower 1-year mortality compared to non-PCI hospitals (24.5% vs. 34.7%; adjusted HR 0.66, 95% CI 0.48-0.90).
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