In-Hospital Coronary Revascularization Rates and Post-Discharge Mortality Risk in Non-ST-Segment Elevation Acute Coronary Syndrome

被引:42
作者
Bueno, Hector [1 ,2 ,3 ,4 ]
Rossello, Xavier [1 ,5 ,6 ]
Pocock, Stuart J. [5 ]
Van de Werf, Frans [7 ]
Chin, Chee Tang [8 ]
Danchin, Nicolas [9 ,10 ]
Lee, Stephen W. -L. [11 ]
Medina, Jesus [12 ]
Huo, Yong [13 ]
机构
[1] CNIC, Melchor Fernandez Almagro 3, Madrid 28029, Spain
[2] Hosp Univ 12 Octubre, Inst Invest I 12, Madrid, Spain
[3] Hosp Univ 12 Octubre, Dept Cardiol, Madrid, Spain
[4] Univ Complutense Madrid, Fac Med, Madrid, Spain
[5] London Sch Hyg & Trop Med, London, England
[6] CIBER Enfermedades CardioVasc, Madrid, Spain
[7] Univ Leuven, Dept Cardiovasc Sci, Leuven, Belgium
[8] Natl Heart Ctr Singapore, Singapore, Singapore
[9] Hop Europeen Georges Pompidou, Paris, France
[10] Rene Descartes Univ, Paris, France
[11] Queen Mary Hosp, Hong Kong, Peoples R China
[12] AstraZeneca, Global Med Affairs, Madrid, Spain
[13] Beijing Univ, Hosp 1, Beijing, Peoples R China
关键词
acute coronary syndrome; coronary revascularization; mortality; risk; country; region; ANTITHROMBOTIC MANAGEMENT PATTERNS; ACUTE MYOCARDIAL-INFARCTION; EURO HEART SURVEY; TERM-FOLLOW-UP; QUALITY INDICATORS; SYNDROMES INSIGHTS; ASSOCIATION; STRATEGIES; RATIONALE; OUTCOMES;
D O I
10.1016/j.jacc.2019.06.068
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND The relationship between in-hospital coronary revascularization rate (CRR) and post-discharge mortality rates in survivors of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) at a system level is unclear. OBJECTIVES The purpose of this study was to evaluate CRR and 2-year post-discharge mortality rate (2YMR) in NSTE-ACS. METHODS CRR and 2YMR were analyzed by hospital rate of CRR (in deciles), by country, and by world region in 11,931 patients with NSTE-ACS who survived to discharge and were enrolled in the EPICOR (long-tErm follow uP of antithrombotic management patterns In acute CORonary syndrome patients) and EPICOR Asia: twin multinational, observational, prospective cohort studies. RESULTS Significant differences in patient baseline characteristics, medical therapies, CRR, and 2YMR were found. Mean CRR ranged from 0.0% to 96.8% in the first and tenth decile, respectively (p < 0.001); from 12.3% in Romania to 92.4% in Slovenia (p < 0.001); and from 53.9% in South East Asia (SEAsia) to 90.4% in South Korea-Singapore-Hong Kong. 2YMR varied significantly between hospital deciles of CRR (3.6% in tenth decile vs. 9.2% in first decile; p < 0.001), countries (lowest 1.5% in Slovenia, highest 19.4% in Malaysia; p < 0.001), and regions (lowest 3.8% in South Korea-Singapore-Hong Kong, highest 11.7% in SEAsia; p < 0.001). Poisson regression models, adjusted for 15 mortality predictors, showed a significant inverse association between CRR and 2YMR for hospitals (r = -0.90; p < 0.001), countries (r = -0.65; p < 0.001), and regions (r = -0.87; p = 0.005). CONCLUSIONS Higher CRRs at the hospital, country, and world region levels are strongly associated with higher post-discharge survival, suggesting CRR as a marker of higher system quality. (C) 2019 by the American College of Cardiology Foundation.
引用
收藏
页码:1454 / 1461
页数:8
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