Impact of hospital proportion and volume on primary percutaneous coronary intervention performance in England and Wales

被引:55
作者
West, Robert M. [1 ]
Cattle, Brian A. [1 ]
Bouyssie, Marianne [1 ,2 ]
Squire, Iain [3 ,4 ]
de Belder, Mark [5 ]
Fox, Keith A. A. [6 ]
Boyle, Roger [7 ]
McLenachan, Jim M. [8 ]
Batin, Philip D. [9 ]
Greenwood, Darren C. [1 ]
Gale, Chris P. [1 ,10 ]
机构
[1] Univ Leeds, Ctr Biostat & Epidemiol, Leeds LS2 9JT, W Yorkshire, England
[2] Univ Toulouse 3, F-31062 Toulouse, France
[3] Univ Leicester, Dept Cardiovasc Sci, Leicester, Leics, England
[4] Glenfield Hosp, Leicester NIHR Biomed Res Unit Cardiovasc Dis, Leicester, Leics, England
[5] S Tees Hosp NHS Fdn Trust, Dept Cardiol, London, England
[6] Univ Edinburgh, Ctr Cardiovasc Sci, Edinburgh, Midlothian, Scotland
[7] Dept Hlth, London SE1 6TE, England
[8] Leeds Teaching Hosp NHS Trust, Dept Cardiol, Leeds, W Yorkshire, England
[9] Midyorkshire Hosp NHS Trust, Dept Cardiol, Wakefield, England
[10] York Teaching Hosp NHS Fdn Trust, Dept Cardiol, York YO31 8HE, N Yorkshire, England
关键词
Primary PCI; STEMI; Door-to-balloon time; Mortality; Hospital volume; Hospital proportion; ELEVATION-MYOCARDIAL-INFARCTION; TO-BALLOON TIME; PRIMARY ANGIOPLASTY VOLUME; ST-ELEVATION; REPERFUSION THERAPY; THROMBOLYTIC THERAPY; FIBRINOLYTIC THERAPY; OUTCOME RELATION; TREATMENT DELAYS; NATIONAL AUDIT;
D O I
10.1093/eurheartj/ehq476
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims To quantify the determinants of primary percutaneous coronary intervention (PCI) performance in England and Wales between 2004 and 2007. Methods and results All 8653 primary PCI cases admitted to acute hospitals in England and Wales as recorded in the Myocardial Ischaemia National Audit Project (MINAP) 2004-2007. We studied the impact of the volume of primary PCI cases (hospital volume) on door-to-balloon (DTB) times and the proportion of patients treated with primary PCI (hospital proportion) on 30-day mortality and employed regression analysis to identify reasons for DTB time variations with a multilevel component to express hospital variation. The proportion of patients receiving primary PCI increased from 5% in 2004 to 20% in 2007. Median DTB times reduced from 84 min in 2004 to 61 min in 2007. Median DTB times decreased as the number of primary PCI procedures increased. The 30-day all-cause mortality rate for hospitals performing primary PCI on > 25% of ST-elevation myocardial infarction patients [5.0%; 95% confidence interval (CI): 3.9-6.1%] was almost double that of hospitals performing primary PCI on more than 75% (2.7%; 95% CI: 2.0-3.5%). Time-of-day, year of admission, sex, and diabetes significantly influenced DTB times. Hospital variation was evident by a hospital-level DTB time standard deviation of 12 min. Conclusions There was a large variation in DTB times between the best and worst performing hospitals. Although patient-related factors impacted upon DTB times, the volume and proportion of patients undergoing primary PCI were significantly associated with delay and early mortality-hospitals with the highest proportion of primary PCI had the lowest mortality.
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页码:706 / +
页数:8
相关论文
共 45 条
[1]  
[Anonymous], 1978, A Practical Guide to Splines
[2]   National Audit of Myocardial Infarction (MINAP): a project in evolution [J].
Birkhead, J ;
Walker, L .
HOSPITAL MEDICINE, 2004, 65 (08) :452-453
[3]   Improving care for patients with acute coronary syndromes: initial results from the National Audit of Myocardial Infarction Project (MINAP) [J].
Birkhead, JS ;
Walker, L ;
Pearson, M ;
Weston, C ;
Cunningham, AD ;
Rickards, AF .
HEART, 2004, 90 (09) :1004-1009
[4]   Trends in the provision of thrombolytic treatment between 1993 and 1997 [J].
Birkhead, JS .
HEART, 1999, 82 (04) :438-442
[5]   Responding to the requirements of the National Service Framework for coronary disease: a core data set for myocardial infarction [J].
Birkhead, JS .
HEART, 2000, 84 (02) :116-117
[6]   Strategies for reducing the door-to-balloon time in acute myocardial infarction [J].
Bradley, Elizabeth H. ;
Herrin, Jeph ;
Wang, Yongfei ;
Barton, Barbara A. ;
Webster, Tashonna R. ;
Mattera, Jennifer A. ;
Roumanis, Sarah A. ;
Curtis, Jeptha P. ;
Nallamothu, Brahmajee K. ;
Magid, David J. ;
McNamara, Robert L. ;
Parkosewich, Janet ;
Loeb, Jerod M. ;
Krumholz, Harlan M. .
NEW ENGLAND JOURNAL OF MEDICINE, 2006, 355 (22) :2308-2320
[7]   The volume of primary angioplasty procedures and survival after acute myocardial infarction [J].
Canto, JG ;
Every, NR ;
Magid, DJ ;
Rogers, WJ ;
Malmgren, JA ;
Frederick, PD ;
French, WJ ;
Tiefenbrunn, AJ ;
Misra, VK ;
Kiefe, CI ;
Barron, HV .
NEW ENGLAND JOURNAL OF MEDICINE, 2000, 342 (21) :1573-1580
[8]   Door-to-balloon times Ups and downs of balloon times [J].
Cattle, Brian A. ;
Greenwood, Darren C. ;
Gale, Christopher P. ;
West, Robert M. .
BRITISH MEDICAL JOURNAL, 2009, 338
[9]  
Cubeddu RJ, 2009, J INVASIVE CARDIOL, V21, P518
[10]   Transfer for primary angioplasty versus immediate thrombolysis in acute myocardial infarction - A meta-analysis [J].
Dalby, M ;
Bouzamondo, A ;
Lechat, P ;
Montalescot, G .
CIRCULATION, 2003, 108 (15) :1809-1814