Laurie J Lambert1, James M Brophy2, Normand Racine3, Stéphane Rinfret4, Philippe L L'Allier3, Kevin A Brown5, Lucy J Boothroyd5, Dave Ross6, Eli Segal7, Simon Kouz8, Sébastien Maire9, Richard Harvey10, Abbas Kezouh11, James Nasmith12, Peter Bogaty13. 1. Unité d'évaluation cardiovasculaire, Institut national d'excellence en santé et en services sociaux (INESSS), Montreal, Québec, Canada. Electronic address: laurie.lambert@inesss.qc.ca. 2. Division of Cardiology, Department of Medicine, McGill University Health Centre, Montreal, Québec, Canada. 3. Department of Medicine, Montreal Heart Institute, Montreal, Québec, Canada. 4. Service de cardiologie, Département multidisciplinaire de cardiologie, Institut universitaire de cardiologie et de pneumologie de Québec, Québec City, Québec, Canada. 5. Unité d'évaluation cardiovasculaire, Institut national d'excellence en santé et en services sociaux (INESSS), Montreal, Québec, Canada. 6. Corporation d'Urgences-santé, Montreal, Québec, Canada; Services préhospitaliers d'urgence en Montérégie, Longueuil, Québec, Canada; Département de médecine préhospitalière, Hôpital Sacré-Cœur de Montréal, Montreal, Québec, Canada. 7. Corporation d'Urgences-santé, Montreal, Québec, Canada; Emergency Department, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Québec, Canada. 8. Service de cardiologie, Département de médecine spécialisée, Centre hospitalier régional de Lanaudière, Joliette, Québec, Canada. 9. Service de médecine d'urgence et de médecine préhospitalière, Département de médecine d'urgence, Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis, Lévis, Québec, Canada. 10. Service de cardiologie, Département de médecine, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada. 11. Lady Davis Institute, Montreal, Québec, Canada. 12. Division of Cardiology, Department of Medicine, St Paul's Hospital, Vancouver, British Columbia, Canada. 13. Unité d'évaluation cardiovasculaire, Institut national d'excellence en santé et en services sociaux (INESSS), Montreal, Québec, Canada; Service de cardiologie, Département multidisciplinaire de cardiologie, Institut universitaire de cardiologie et de pneumologie de Québec, Québec City, Québec, Canada.
Abstract
BACKGROUND: Hospitals treating patients with ST-elevation myocardial infarction (STEMI) may show good results with reperfusion treatment (fibrinolysis or primary percutaneous coronary intervention [PPCI]), but a comprehensive evaluation should factor in outcomes of patients with STEMI who do not receive reperfusion. We compared outcomes of patients receiving and not receiving reperfusion within a complete system of STEMI care by hospital type: PPCI centres, fibrinolysis centres, centres that only transfer for PPCI, and centres providing a mix of fibrinolysis and PPCI transfer. METHODS: All patients presenting to 82 Quebec hospitals with characteristic symptoms, a final diagnosis of acute myocardial infarction, and core-laboratory confirmed STEMI over two 6-month periods were studied. RESULTS: Of the total 3731 patients with STEMI, 2918 (78.2%) received reperfusion treatment (81% PPCI, 19% fibrinolysis); 813 (21.8%) did not. For reperfusion-treated patients, 30-day mortality was 5.4% in PPCI centres, 5.4% in fibrinolysis centres, 6.9% in transfer PPCI centres, and 6.0% in mixed centres (P = 0.55). For untreated patients, 30-day mortality was 15.7% (PPCI centres), 16.1% (fibrinolysis centres), 21.8% (transfer PPCI), and 24.6% (mixed) (P = 0.08). Adjusted mortality odds ratios for all patients were 1.00 (PPCI centres), 1.50 (95% CI: 0.97-2.32; fibrinolysis centres), 1.30 (0.95-1.78; transfer PPCI centres), and 1.58 (1.09-2.29; mixed centres). PPCI was within recommended delays in 35.4%, 11.9%, and 1.2% of PPCI, transfer, and mixed centres, respectively. CONCLUSIONS: Mixed centres had the highest crude and adjusted all-patient 30-day STEMI mortality. Relatively good outcomes of reperfusion-treated patients, despite long treatment delays, can misrepresent overall performance if untreated patients are not examined.
BACKGROUND: Hospitals treating patients with ST-elevation myocardial infarction (STEMI) may show good results with reperfusion treatment (fibrinolysis or primary percutaneous coronary intervention [PPCI]), but a comprehensive evaluation should factor in outcomes of patients with STEMI who do not receive reperfusion. We compared outcomes of patients receiving and not receiving reperfusion within a complete system of STEMI care by hospital type: PPCI centres, fibrinolysis centres, centres that only transfer for PPCI, and centres providing a mix of fibrinolysis and PPCI transfer. METHODS: All patients presenting to 82 Quebec hospitals with characteristic symptoms, a final diagnosis of acute myocardial infarction, and core-laboratory confirmed STEMI over two 6-month periods were studied. RESULTS: Of the total 3731 patients with STEMI, 2918 (78.2%) received reperfusion treatment (81% PPCI, 19% fibrinolysis); 813 (21.8%) did not. For reperfusion-treated patients, 30-day mortality was 5.4% in PPCI centres, 5.4% in fibrinolysis centres, 6.9% in transfer PPCI centres, and 6.0% in mixed centres (P = 0.55). For untreated patients, 30-day mortality was 15.7% (PPCI centres), 16.1% (fibrinolysis centres), 21.8% (transfer PPCI), and 24.6% (mixed) (P = 0.08). Adjusted mortality odds ratios for all patients were 1.00 (PPCI centres), 1.50 (95% CI: 0.97-2.32; fibrinolysis centres), 1.30 (0.95-1.78; transfer PPCI centres), and 1.58 (1.09-2.29; mixed centres). PPCI was within recommended delays in 35.4%, 11.9%, and 1.2% of PPCI, transfer, and mixed centres, respectively. CONCLUSIONS: Mixed centres had the highest crude and adjusted all-patient 30-day STEMI mortality. Relatively good outcomes of reperfusion-treated patients, despite long treatment delays, can misrepresent overall performance if untreated patients are not examined.
Authors: Azadeh Mofid; Nadav S Newman; Paul J H Lee; Cynthia Abbasi; Pratiek N Matkar; Dmitriy Rudenko; Michael A Kuliszewski; Hao H Chen; Kolsoom Afrasiabi; James N Tsoporis; Anthony O Gramolini; Kim A Connelly; Thomas G Parker; Howard Leong-Poi Journal: J Am Heart Assoc Date: 2017-02-07 Impact factor: 5.501