STEMI mortality in community hospitals versus PCI-capable hospitals: results from a nationwide STEMI network programme

Claeys, Marc J.; Sinnaeve, Peter; Convens, Carl; Dubois, Philippe; Boland, Jean; Vranckx, Pascal; Gevaert, Sofie; Meester, A. De; Coussement, Patrick; Raedt, Herbert De; Beauloye, Christophe; Renard, Marc; Vrints, Christiaan J.; Evrard, Patrick

doi:10.1177/2048872612441579

Cited by 22 publications

(24 citation statements)

References 24 publications

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“…Because OCT was used at the discretion of the operator in the current study, patients with worse conditions would be less likely to undergo OCT examination. In the current study and the latest OCT studies [15,16], the frequency of cardiac death was approximately 2-3%, which is lower than values in the latest large-scale registry [30]. …”

Section: Discussionmentioning

confidence: 98%

Features and Outcomes of Patients with Calcified Nodules at Culprit Lesions of Acute Coronary Syndrome: An Optical Coherence Tomography Study

Kobayashi

Takano

Tsurumi³

et al. 2018

Cardiology

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Objectives: We sought to clarify clinical features and outcomes related to calcified nodules (CN) compared with plaque rupture (PR) and plaque erosion (PE) detected by optical coherence tomography (OCT) at the culprit lesions in patients with acute coronary syndrome (ACS). Methods: Based on OCT findings for culprit lesion plaque morphologies, ACS patients with analyzable OCT images (n = 362) were classified as CN, PR, PE, and other. Results: The prevalence of CN, PR, and PE was 6% (n = 21), 45% (n = 163), and 41% (n = 149), respectively. Patients with CN were older (median 71 vs. 65 years, p = 0.03) and more diabetic (71 vs. 35%, p = 0.002) than those without CN. In OCT findings, the distal reference lumen cross-sectional area (median 4.2 vs. 5.2 mm², p = 0.048) and the postintervention minimum lumen cross-sectional area (median 4.5 vs. 5.3 mm², p = 0.04) were smaller in lesions with CN than in those without. Kaplan-Meier estimate survival curves showed that the 500-day survival without target lesion revascularization (TLR) was lower (p = 0.011) for patients with CN (72.9%) than for those with PR (89.3%) or PE (94.8%). Conclusions: ACS patients with CN at the culprit lesion had more TLR compared to those with PR or PE.

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Section: Discussionmentioning

confidence: 98%

Features and Outcomes of Patients with Calcified Nodules at Culprit Lesions of Acute Coronary Syndrome: An Optical Coherence Tomography Study

Kobayashi

Takano

Tsurumi³

et al. 2018

Cardiology

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“…A specific challenge to understanding this issue is finding comprehensive, national data sources that also include detailed clinical information. A recent Swedish study evaluated gender differences in treatment and outcome of STEMI patients in 1998−2000 vs. 13 Accordingly, we used the Acute Myocardial Infarction in Switzerland (AMIS) Plus registry to evaluate temporal trends in presentation, treatment, and outcome in men and women with STEMI in Switzerland between 1997 and 2011. The advantages of the AMIS Plus registry include its inclusiveness and rich data sources that allow for detailed assessments of processes of care and in-hospital outcomes.…”

Section: Introductionmentioning

confidence: 99%

Temporal trends in treatment of ST-elevation myocardial infarction among men and women in Switzerland between 1997 and 2011

Radovanovic

Nallamothu

Seifert

et al. 2012

European Heart Journal: Acute Cardiovascular Care

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Background: Few data are available concerning the impact of gender on temporal trends in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods: All STEMI patients consecutively enrolled in the AMIS (Acute Myocardial Infarction in Switzerland) Plus project from 1997−2011 were included. Temporal trends in presentation, treatment and outcomes were analyzed using multiple logistic regressions with generalized estimations. Results: Of 21,620 STEMI patients, 5786 were women and 15,834 men from 78 Swiss hospitals. Women were 8.6 years older, presented 48 minutes later with less pain, but more dyspnea, and more frequently had atrial fibrillation (5.5 vs. 3.9%, p<0.001), heart failure (Killip class >2) (9.7 vs. 7.3%, p<0.001), and moderate or severe comorbidities (24.8 vs. 18.2%, p<0.001). Women were less likely to undergo primary reperfusion treatment after adjustment for baseline characteristics and admission year (OR 0.80, 95% CI 0.71−0.90, p<0.001) or receive early and discharge drugs, such as thienopyridines, angiotensin-converting-enzyme inhibitors, angiotensin II receptor antagonists, and statins. In 1997, thrombolysis was performed in 51% of male and 39% of female patients; its use rapidly decreased during the 1990s and has now become negligible. Primary percutaneous coronary intervention increased from under 10% in both genders in 1997 to over 70% in females and over 80% in males since 2006. Patients admitted in cardiogenic shock increased by 8% per year in both genders. The incidence of both reinfarction and cardiogenic shock developing during hospitalization decreased significantly over 15 years while in-hospital mortality decreased from 10 to 5% in men and from 18 to 7% in women. This corresponds to a relative reduction of 5% per year for males (OR 0.95, p=0.006) and 6% per year for female STEMI patients (OR 0.94, p<0.001). Despite higher crude in-hospital mortality, female gender per se was not an independent predictor of in-hospital mortality (OR 1.07, 95% CI 0.84−1.35, p=0.59). Conclusion: Substantial changes have occurred in presentation, treatment, and outcome of men and women with STEMI in Switzerland over the past 15 years. Although parallel trends were seen in both groups, ongoing disparities in certain treatments remain. However, these did not translate into worse risk-adjusted in-hospital mortality, suggesting that the gender gap in STEMI care may be closing.

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“…Second, though progress has been made in emergency reperfusion therapy, its rate remained relatively low when compared to those in other studies, particularly the primary PCI therapy. [323334] Third, higher degree of Killip class was observed in 2015 than that in 2010 (35.48% vs. 29.16%), indicating increased severity of STEMI on presentation. This in turn would offset the beneficial effects gained from improved reperfusion therapy and the quality of care.…”

Section: Discussionmentioning

confidence: 97%

Current Trends for ST-segment Elevation Myocardial Infarction during the Past 5 Years in Rural Areas of China's Liaoning Province

Zhou

et al. 2017

Chinese Medical Journal

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Background:Since 2010, two versions of National Guidelines aimed at promoting the management of ST-segment elevation myocardial infarction (STEMI) have been formulated by the Chinese Society of Cardiology. However, little is known about the changes in clinical characteristics, management, and in-hospital outcomes in rural areas.Methods:In the present multicenter, cross-sectional study, participants were enrolled from rural hospitals located in Liaoning province in Northeast China, during two different periods (from June 2009 to June 2010 and from January 2015 to December 2015). Data collection was conducted using a standardized questionnaire. In total, 607 and 637 STEMI patients were recruited in the 2010 and 2015 cohorts, respectively.Results:STEMI patients in rural hospitals were older in the second group (63 years vs. 65 years, P = 0.039). We found increases in the prevalence of hypertension, prior percutaneous coronary intervention (PCI), and prior stroke. Over the past 5 years, the cost during hospitalization almost doubled. The proportion of STEMI patients who underwent emergency reperfusion had significantly increased from 42.34% to 54.47% (P < 0.0001). Concurrently, the proportion of primary PCI increased from 3.62% to 10.52% (P < 0.0001). The past 5 years have also seen marked increases in the use of guideline-recommended drugs and clinical examinations. However, in-hospital mortality and major adverse cardiac events did not significantly change over time (13.01% vs. 10.20%, P = 0.121; 13.34% vs. 13.66%, P = 0.872).Conclusions:Despite the great progress that has been made in guideline-recommended therapies, in-hospital outcomes among rural STEMI patients have not significantly improved. Therefore, there is still substantial room for improvement in the quality of care.

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STEMI mortality in community hospitals versus PCI-capable hospitals: results from a nationwide STEMI network programme

Abstract: 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.

Cited by 22 publications

References 24 publications

Features and Outcomes of Patients with Calcified Nodules at Culprit Lesions of Acute Coronary Syndrome: An Optical Coherence Tomography Study

Features and Outcomes of Patients with Calcified Nodules at Culprit Lesions of Acute Coronary Syndrome: An Optical Coherence Tomography Study

Temporal trends in treatment of ST-elevation myocardial infarction among men and women in Switzerland between 1997 and 2011

Current Trends for ST-segment Elevation Myocardial Infarction during the Past 5 Years in Rural Areas of China's Liaoning Province

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