Key result
Community hospital admission for STEMI shows comparable in-hospital mortality to PCI-capable centers.
Why the study?
More data are needed on management and outcome of an unselected community-based STEMI population to validate the concept of STEMI networks in a real-world context.
Does admission to community hospitals compared to PCI-capable hospitals affect in-hospital mortality in STEMI patients within a nationwide network?
Observational (n=8,500)
Yes
Does admission to community hospitals compared to PCI-capable hospitals affect in-hospital mortality in STEMI patients within a nationwide network?
Odds Ratio: 1.1 (95% CI 0.8–1.4)
Absolute Event Rate: 7% vs 6.7%
In a nationwide STEMI network, in-hospital mortality was comparable between patients admitted to community hospitals and those admitted directly to PCI-capable hospitals.
Comparable mortality supports current STEMI network transfers; leaves open unmeasured confounding and selection bias in observational data.
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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Claeys et al. (2012) conducted an observational in ST elevation myocardial infarction (STEMI) (n=8,500). Admission to community hospitals vs. Admission to PCI-capable hospitals was evaluated on In-hospital mortality (OR 1.1, 95% CI 0.8-1.4). Admission to community hospitals for STEMI resulted in comparable in-hospital mortality to PCI-capable hospitals (7.0% vs 6.7%; adjusted OR 1.1, 95% CI 0.8-1.4).
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