Part 9: Acute Coronary Syndromes

O’Connor, Robert E.; Ali, Abdulaziz S. Al; Brady, William J.; Ghaemmaghami, Chris A.; Menon, Venu; Welsford, Michelle; Shüster, Michael

doi:10.1161/cir.0000000000000263

Cited by 103 publications

(50 citation statements)

References 116 publications

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“…However, a small but still substantial subset of AMI patients arrive at the hospital after being initially treated and potentially stabilized at another facility. The practice of transferring certain patients to facilities with more advanced treatment capabilities is recommended by the American Heart Association (AHA; see Neumar et al, 2015 and O’Connor et al, 2015). For example, the AHA recommends that hospitals unable to perform angioplasty transfer patients whose heart attacks are appropriate for such treatment to facilities able to perform it.…”

Section: Mechanismmentioning

confidence: 99%

Health Care Exceptionalism? Performance and Allocation in the US Health Care Sector

Chandra

Finkelstein

Sacarny

et al. 2016

American Economic Review

187

109

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The conventional wisdom for the healthcare sector is that idiosyncratic features leave little scope for market forces to allocate consumers to higher performance producers. However, we find robust evidence - across several different conditions and performance measures - that higher quality hospitals have higher market shares and grow more over time. The relationship between performance and allocation is stronger among patients who have greater scope for hospital choice, suggesting that patient demand plays an important role in allocation. Our findings suggest that healthcare may have more in common with “traditional” sectors subject to market forces than often assumed.

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Section: Mechanismmentioning

confidence: 99%

Health Care Exceptionalism? Performance and Allocation in the US Health Care Sector

Chandra

Finkelstein

Sacarny

et al. 2016

American Economic Review

187

109

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“…Primary percutaneous coronary intervention (P-PCI) is the treatment of choice for patients with ST-segment elevation myocardial infarction (STEMI) [1]. Around 30%, patients with multi-vessel disease (MVD) have significant stenoses seen in 1 or more non-infarct related arteries (N-IRA) during index angiography, a negative prognostic predictor of long-term outcome [2].…”

Section: Introductionmentioning

confidence: 99%

“…Around 30%, patients with multi-vessel disease (MVD) have significant stenoses seen in 1 or more non-infarct related arteries (N-IRA) during index angiography, a negative prognostic predictor of long-term outcome [2]. This notwithstanding, treatment of N-IRA lesions is not recommended by current guidelines unless hemodynamic compromise or residual ischemia are present [1]. Literature reports give conflicting results and sufficiently powered randomized [3][4][5][6][7][8][9] clinical trials are lacking [10,11].…”

Section: Introductionmentioning

confidence: 99%

Comparative Effectiveness of Complete Revascularization versus Infarct Related Artery-only Percutaneous Coronary Revascularization for Multivessel Disease after ST-Segment Elevation Myocardial Infarction

Jayaraj¹,

Abrahamyan²,

Demirchyan³

2016

ICFJ

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Objectives: The purpose of this study was to evaluate the event free survival from major adverse cardiac events (MACE) for ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease as a function of whether they underwent infarct-related artery (IRA) only percutaneous coronary intervention (PCI) or complete revascularization at index admission.Background: The optimal management of patients with STEMI and multivessel disease while undergoing primary percutaneous coronary intervention (P-PCI) is uncertain.Methods and Results: STEMI patients with multivessel disease undergoing P-PCI between April 1, 2012, and March 31, 2014, were subdivided into those who underwent in-hospital complete revascularization (n= 150) or IRA-only revascularization (n = 156). Complete revascularization was performed during the index admission of P-PCI. The primary endpoint was a composite of all-cause death, recurrent myocardial infarction (MI), heart failure, and ischemia-driven revascularization within 24 months. Patient groups were differed at baseline by gender and prevalence of heart failure. The average door-to-balloon time was significantly higher in the complete revascularization group. The primary endpoint occurred in 11.0% of the complete revascularization group versus 23% in the IRA-only revascularization group (hazard ratio: 0.51; 95% confidence interval: 0.34 to 0.93; p =0.039). There was a significant reduction in death, a non-significant reduction in all primary endpoint components was seen. <span style="font-size: 12.0pt; line-height: 115%; font-family: 'Times New Roman','serif'; mso-fareast-font-family: 'Times New Roman'; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: EN-US;">Conclusions:<span style="font-size: 12.0pt; line-height: 115%; font-family: 'Times New Roman','serif'; mso-fareast-font-family: 'Times New Roman'; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: EN-US;"> In patients presenting for P-PCI with multivessel disease, index admission complete revascularization significantly lowered the rate of the primary composite endpoint at 24 months compared with treating only the IRA.

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“…Similarly, implantable‐cardioverter defibrillator implantation in the Utstein subgroup remained stable over time. Although revascularization is recommended for OHCA patients with ST‐segment–elevation myocardial infarction and predischarge implantable‐cardioverter defibrillator implantation is recommended in clinically appropriate patients, the present data set does not permit the adjudication of the appropriateness of these procedures 31, 32, 33…”

Section: Discussionmentioning

confidence: 90%

Multistate 5‐Year Initiative to Improve Care for Out‐of‐Hospital Cardiac Arrest: Primary Results From the HeartRescue Project

Diepen

Girotra

Abella

et al. 2017

JAHA

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BackgroundThe HeartRescue Project is a multistate public health initiative focused on establishing statewide out‐of‐hospital cardiac arrest (OHCA) systems of care to improve case capture and OHCA care in the community, by emergency medical services (EMS), and at hospital level.Methods and ResultsFrom 2011 to 2015 in the 5 original HeartRescue states, all adults with EMS–treated OHCA due to a presumed cardiac cause were included. In an adult population of 32.8 million, a total of 64 988 OHCAs—including 10 046 patients with a bystander‐witnessed OHCA with a shockable rhythm—were treated by 330 EMS agencies. From 2011 to 2015, the case‐capture rate for all‐rhythm OHCA increased from an estimated 39.0% (n=6762) to 89.2% (n=16 103; P<0.001 for trend). Overall survival to hospital discharge was 11.4% for all rhythms and 34.0% in the subgroup with bystander‐witnessed OHCA with a shockable rhythm. We observed modest temporal increases in bystander cardiopulmonary resuscitation (41.8–43.5%, P<0.001 for trend) and bystander automated external defibrillator application (3.2–5.6%, P<0.001 for trend) in the all‐rhythm group, although there were no temporal changes in survival. There were marked all‐rhythm survival differences across the 5 states (8.0–16.1%, P<0.001) and across participating EMS agencies (2.7–26.5%, P<0.001).ConclusionsIn the initial 5 years, the HeartRescue Project developed a population‐based OHCA registry and improved statewide case‐capture rates and some processes of care, although there were no early temporal changes in survival. The observed survival variation across states and EMS systems presents a future challenge to elucidate the characteristics of high‐performing systems with the goal of improving OHCA care and survival.

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Part 9: Acute Coronary Syndromes

Abstract: MethodologyILCOR performed 18 systematic reviews (14 based on meta-analyses) on more than 110 relevant studies that span

Cited by 103 publications

References 116 publications

Health Care Exceptionalism? Performance and Allocation in the US Health Care Sector

Health Care Exceptionalism? Performance and Allocation in the US Health Care Sector

Comparative Effectiveness of Complete Revascularization versus Infarct Related Artery-only Percutaneous Coronary Revascularization for Multivessel Disease after ST-Segment Elevation Myocardial Infarction

Multistate 5‐Year Initiative to Improve Care for Out‐of‐Hospital Cardiac Arrest: Primary Results From the HeartRescue Project

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