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

被引：23

作者：

Claeys, Marc J. ^{[1
]}

Sinnaeve, Peter R. ^{[2
]}

Convens, Carl ^{[3
]}

Dubois, Philippe ^{[4
]}

Boland, Jean ^{[5
]}

Vranckx, Pascal ^{[6
]}

Gevaert, Sofie ^{[7
]}

de Meester, Antoine ^{[8
]}

Coussement, Patrick ^{[9
]}

De Raedt, Herbert ^{[10
]}

Beauloye, Christophe ^{[11
]}

Renard, Marc ^{[12
]}

Vrints, Christiaan ^{[1
]}

Evrard, Patrick ^{[13
]}

机构：

[1] Univ Hosp Antwerp, Edegem, Belgium

[2] Univ Hosp Leuven, Leuven, Belgium

[3] Ziekenhuis Netwerk Antwerpen, Antwerp, Belgium

[4] Ctr Hosp Univ Charleroi, Charleroi, Belgium

[5] Ctr Hosp Reg Citadelle, Liege, Belgium

[6] Virga Jesse Ziekenhuis, Hasselt, Belgium

[7] Univ Hosp Gent, Ghent, Belgium

[8] Hop Jolimont, Jolimont, Belgium

[9] Algemeen Ziekenhuis St Jan, Brugge, Belgium

[10] Onze Lieve Vrouw Hosp, Aalst, Belgium

[11] Catholic Univ Louvain, Louvain, Belgium

[12] Univ Libre Bruxelles, Brussels, Belgium

[13] Clin Univ Mt Godinne, Yvoir, Belgium

来源：

EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE | 2012年 / 1卷 / 01期

关键词：

ST elevation myocardial infarction; primary PCI; networks;

D O I：

10.1177/2048872612441579

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Aims: Reports examining local ST elevation myocardial infarction (STEMI) networks focused mainly on percutaneous coronary intervention (PCI)-related time issues and outcomes. To validate the concept of STEMI networks in a realworld context, more data are needed on management and outcome of an unselected community based STEMI population. Methods and results: The current study evaluated reperfusion strategies and in-hospital mortality in 8500 unselected STEMI patients admitted to 47 community hospitals (n = 3053) and 25 PCI-capable hospitals (n= 5447) in the context of a nationwide STEMI network programme that started in 2007 in Belgium. The distance between the hub and spoke hospitals ranged from 2.2 to 47 km (median 15 km). A propensity score was used to adjust for differences in baseline characteristics. Reperfusion strategy was significantly different with a predominant use of primary PCI (pPCI) in PCIcapable hospitals (93%), compared to a mixed use of pPCI (71%) and thrombolysis (20%) in community hospitals. A door-to-balloon time < 120 min was achieved in 83% of community hospitals and in 91% of PCI-capable hospitals (p< 0.0001). In-hospital mortality was 7.0% in community hospitals versus 6.7% in PCI-capable hospitals with an adjusted odds ratio of 1.1 (95% confidence interval: 0.8-1.4). Between the periods 2007-2008 and 2009-2010, the pPCI rate in community hospitals increased from 60% to 80%, whereas the proportion of conservatively managed patients decreased from 11.1% to 7.9%. Conclusion: 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.

引用

页码：40 / 47

页数：8

共 24 条

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