No abstract

The CREATE-ECLA Randomized Controlled TrialThe CREATE-ECLA Trial Group Investigators* See also pp 427 and 489.

BackgroundSocioeconomic status (SES) as reflected by residential zip code status may detrimentally influence a number of prehospital clinical, access‐related, and transport variables that influence outcome for patients with ST‐elevation myocardial infarction (STEMI) undergoing reperfusion. We sought to analyze the impact of SES on in‐hospital mortality, timely reperfusion, and cost of hospitalization following STEMI.Methods and ResultsWe used the 2003–2011 Nationwide Inpatient Sample database for this analysis. All hospital admissions with a principal diagnosis of STEMI were identified using ICD‐9 codes. SES was assessed using median household income of the residential zip code for each patient. There was a significantly higher mortality among the lowest SES quartile as compared to the highest quartile (OR [95% CI]: 1.11 [1.06 to 1.17]). Similarly, there was a highly significant trend indicating a progressively reduced timely reperfusion among patients from lower quartiles (OR [95% CI]: 0.80 [0.74 to 0.88]). In addition, there was a lower utilization of circulatory support devices among patients from lower as compared to higher zip code quartiles (OR [95% CI]: 0.85 [0.75 to 0.97]). Furthermore, the mean adjusted cost of hospitalization among quartiles 2, 3, and 4, as compared to quartile 1 was significantly higher by $913, $2140, and $4070, respectively.ConclusionsPatients residing in zip codes with lower SES had increased in‐hospital mortality and decreased timely reperfusion following STEMI as compared to patients residing in higher SES zip codes. The cost of hospitalization of patients from higher SES quartiles was significantly higher than those from lower quartiles.

Our systematic review suggested comparable efficacy of LAA occlusion devices compared with historical controls treated with adjusted-dose warfarin and other anticoagulation strategies for prevention of stroke in patients with NVAF.

In patients with acute-onset AF, odds of thromboembolic complications were almost 5 times higher in patients without therapeutic anticoagulation at the time of cardioversion. However, no events occurred in post-operative patients and in those with CHADS-VASc scores of <2, supporting the utility of accurate assessment of AF onset and risk stratification in determining the need for anticoagulation for cardioversion of AF <48 h in duration.