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Outcomes of Myocardial Infarction in Hospitals With Percutaneous Coronary Intervention Facilities

2007; American Medical Association; Volume: 167; Issue: 9 Linguagem: Inglês

10.1001/archinte.167.9.913

1538-3679

José Labarère, Loïc Belle, Magali Fourny, N Genès, Jean‐Marc Lablanche, Didier Blanchard, Jean-Pierre Cambou, Nicolas Danchin,

Heart Failure Treatment and Management

Background: Despite evidence on the efficacy and safety of percutaneous coronary intervention (PCI) for patients with acute myocardial infarction, it is unclear whether patients admitted to hospitals with on-site PCI facilities (hereinafter, PCI hospitals) have improved outcomes in routine practice. Methods:We compared processes of care, hospital outcomes, and 1-year mortality rate for 1176 consecutive patients admitted to 126 PCI hospitals and 738 patients admitted to 190 non-PCI hospitals in France from November 1 to November 30, 2000.Results: Patients admitted to PCI hospitals were more likely to receive evidence-based acute (within 48 hours of admission) and discharge medications and to undergo PCI within 48 hours of admission than those admitted to non-PCI hospitals (54% vs 6.2%; PϽ.001).Despite comparable rates of in-hospital stroke (0.9% vs 1.1%; P = .75)and reinfarction (1.7% vs 2.5%; P = .25),patients admitted to PCI vs non-PCI hospitals had lower in-hospital (7.5% vs 12%; P =.001) and 1-year (13% vs 20%; PϽ.001) mortality rates.Admission to PCI hospitals was associated with decreased hazard ratios of mortality after adjusting for baseline characteristics (0.75; 95% confidence interval, 0.57-0.98)or propensity score (0.76; 95% confidence interval, 0.59-0.97).Most of the survival benefit of admission to a PCI hospital was explained by the use of PCI and evidence-based discharge medications.