Héctor Bueno1, Xavier Rossello2, Stuart J Pocock3, Frans Van de Werf4, Chee Tang Chin5, Nicolas Danchin6, Stephen W-L Lee7, Jesús Medina8, Yong Huo9. 1. Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Instituto de Investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain. Electronic address: hector.bueno@cnic.es. 2. Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; London School of Hygiene and Tropical Medicine, London, United Kingdom; CIBER de Enfermedades CardioVasculares, Madrid, Spain. Electronic address: https://twitter.com/RosselloXavier. 3. London School of Hygiene and Tropical Medicine, London, United Kingdom. 4. Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium. 5. National Heart Centre Singapore, Singapore. 6. Hôpital Européen Georges Pompidou & René Descartes University, Paris, France. 7. Queen Mary Hospital, Hong Kong SAR, China. 8. Global Medical Affairs, AstraZeneca, Madrid, Spain. 9. Beijing University First Hospital, Beijing, China.
Abstract
BACKGROUND: The relationship between in-hospital coronary revascularization rate (CRR) and post-discharge mortality rates in survivors of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) at a system level is unclear. OBJECTIVES: The purpose of this study was to evaluate CRR and 2-year post-discharge mortality rate (2YMR) in NSTE-ACS. METHODS: CRR and 2YMR were analyzed by hospital rate of CRR (in deciles), by country, and by world region in 11,931 patients with NSTE-ACS who survived to discharge and were enrolled in the EPICOR (long-tErm follow uP of antithrombotic management patterns In acute CORonary syndrome patients) and EPICOR Asia: twin multinational, observational, prospective cohort studies. RESULTS: Significant differences in patient baseline characteristics, medical therapies, CRR, and 2YMR were found. Mean CRR ranged from 0.0% to 96.8% in the first and tenth decile, respectively (p < 0.001); from 12.3% in Romania to 92.4% in Slovenia (p < 0.001); and from 53.9% in South East Asia (SEAsia) to 90.4% in South Korea-Singapore-Hong Kong. 2YMR varied significantly between hospital deciles of CRR (3.6% in tenth decile vs. 9.2% in first decile; p < 0.001), countries (lowest 1.5% in Slovenia, highest 19.4% in Malaysia; p < 0.001), and regions (lowest 3.8% in South Korea-Singapore-Hong Kong, highest 11.7% in SEAsia; p < 0.001). Poisson regression models, adjusted for 15 mortality predictors, showed a significant inverse association between CRR and 2YMR for hospitals (r = -0.90; p < 0.001), countries (r = -0.65; p < 0.001), and regions (r = -0.87; p = 0.005). CONCLUSIONS: Higher CRRs at the hospital, country, and world region levels are strongly associated with higher post-discharge survival, suggesting CRR as a marker of higher system quality.
BACKGROUND: The relationship between in-hospital coronary revascularization rate (CRR) and post-discharge mortality rates in survivors of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) at a system level is unclear. OBJECTIVES: The purpose of this study was to evaluate CRR and 2-year post-discharge mortality rate (2YMR) in NSTE-ACS. METHODS: CRR and 2YMR were analyzed by hospital rate of CRR (in deciles), by country, and by world region in 11,931 patients with NSTE-ACS who survived to discharge and were enrolled in the EPICOR (long-tErm follow uP of antithrombotic management patterns In acute CORonary syndromepatients) and EPICOR Asia: twin multinational, observational, prospective cohort studies. RESULTS: Significant differences in patient baseline characteristics, medical therapies, CRR, and 2YMR were found. Mean CRR ranged from 0.0% to 96.8% in the first and tenth decile, respectively (p < 0.001); from 12.3% in Romania to 92.4% in Slovenia (p < 0.001); and from 53.9% in South East Asia (SEAsia) to 90.4% in South Korea-Singapore-Hong Kong. 2YMR varied significantly between hospital deciles of CRR (3.6% in tenth decile vs. 9.2% in first decile; p < 0.001), countries (lowest 1.5% in Slovenia, highest 19.4% in Malaysia; p < 0.001), and regions (lowest 3.8% in South Korea-Singapore-Hong Kong, highest 11.7% in SEAsia; p < 0.001). Poisson regression models, adjusted for 15 mortality predictors, showed a significant inverse association between CRR and 2YMR for hospitals (r = -0.90; p < 0.001), countries (r = -0.65; p < 0.001), and regions (r = -0.87; p = 0.005). CONCLUSIONS: Higher CRRs at the hospital, country, and world region levels are strongly associated with higher post-discharge survival, suggesting CRR as a marker of higher system quality.
Authors: Roberto Martín-Asenjo; John Gregson; Xavier Rossello; Frans Van de Werf; Jesús Medina; Nicolas Danchin; Stuart Pocock; Héctor Bueno Journal: J Cardiovasc Transl Res Date: 2021-01-08 Impact factor: 4.132
Authors: Yong Huo; Frans Van de Werf; Yaling Han; Xavier Rossello; Stuart J Pocock; Chee Tang Chin; Stephen W-L Lee; Yi Li; Jie Jiang; Ana Maria Vega; Jesús Medina; Héctor Bueno Journal: Am J Cardiovasc Drugs Date: 2021-02-04 Impact factor: 3.571
Authors: Brian A Bergmark; Njambi Mathenge; Piera A Merlini; Marilyn B Lawrence-Wright; Robert P Giugliano Journal: Lancet Date: 2022-04-02 Impact factor: 79.321