Relation between hospital specialization with primary percutaneous coronary intervention and clinical outcomes in ST-segment elevation myocardial infarction : National registry of myocardial infarction-4 analysis
Hospitals with primary percutaneous coronary intervention (PPCI) capability may choose to predominately offer PPCI to their patients with ST-segment elevation myocardial infarction (STEMI), or they may selectively offer PPCI or fibrinolytic therapy based on patient and hospital-level factors. Whethe...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2006-01, Vol.113 (2), p.222-229 |
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| creator | NALLAMOTHU, Brahmajee K YONGFEI WANG MAGID, David J MCNAMARA, Robert L HERRIN, Jeph BRADLEY, Elizabeth H BATES, Eric R POLLACK, Charles V KRUMHOLZ, Harlan M |
| description | Hospitals with primary percutaneous coronary intervention (PPCI) capability may choose to predominately offer PPCI to their patients with ST-segment elevation myocardial infarction (STEMI), or they may selectively offer PPCI or fibrinolytic therapy based on patient and hospital-level factors. Whether a greater level of hospital specialization with PPCI is associated with better quality of care is unknown.
We analyzed data from the National Registry of Myocardial Infarction-4 to compare in-hospital mortality and times to treatment in STEMI across different levels of hospital specialization with PPCI. We divided 463 hospitals into quartiles of PPCI specialization based on the relative proportion of reperfusion-treated patients who underwent PPCI (< or =34.0%, >34.0 to 62.5%, >62.5 to 88.5%, >88.5%). Hierarchical multivariable regression assessed whether PPCI specialization was associated with better outcomes, after adjusting for patient and hospital characteristics, including PPCI volume. We found that greater PPCI specialization was associated with a lower relative risk of in-hospital mortality in patients treated with PPCI (adjusted relative risk comparing the highest and lowest quartiles, 0.64; P=0.006) but not in those treated with fibrinolytic therapy. Compared with patients at hospitals in the lowest quartile of PPCI specialization, adjusted door-to-balloon times in the highest quartile were significantly shorter (99.6 versus 118.3 minutes; P |
| doi_str_mv | 10.1161/CIRCULATIONAHA.105.578195 |
| format | Article |
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We analyzed data from the National Registry of Myocardial Infarction-4 to compare in-hospital mortality and times to treatment in STEMI across different levels of hospital specialization with PPCI. We divided 463 hospitals into quartiles of PPCI specialization based on the relative proportion of reperfusion-treated patients who underwent PPCI (< or =34.0%, >34.0 to 62.5%, >62.5 to 88.5%, >88.5%). Hierarchical multivariable regression assessed whether PPCI specialization was associated with better outcomes, after adjusting for patient and hospital characteristics, including PPCI volume. We found that greater PPCI specialization was associated with a lower relative risk of in-hospital mortality in patients treated with PPCI (adjusted relative risk comparing the highest and lowest quartiles, 0.64; P=0.006) but not in those treated with fibrinolytic therapy. Compared with patients at hospitals in the lowest quartile of PPCI specialization, adjusted door-to-balloon times in the highest quartile were significantly shorter (99.6 versus 118.3 minutes; P<0.001), and the likelihood of door-to-balloon times exceeding 90 minutes was significantly lower (relative risk, 0.78; P<0.001). Adjusting for PPCI specialization diminished the association between PPCI volume and clinical outcomes.
Greater specialization with PPCI is associated with lower in-hospital mortality and shorter door-to-balloon times in STEMI patients treated with PPCI.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/CIRCULATIONAHA.105.578195</identifier><identifier>PMID: 16401769</identifier><identifier>CODEN: CIRCAZ</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Angioplasty, Balloon - mortality ; Angioplasty, Balloon - statistics & numerical data ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiology. Vascular system ; Coronary heart disease ; Data Collection ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Electrocardiography ; Emergency Medical Services ; Female ; Heart ; Hospital Mortality ; Hospitals, Special - standards ; Humans ; Male ; Medical sciences ; Middle Aged ; Myocardial Infarction - mortality ; Myocardial Infarction - surgery ; Myocardial Infarction - therapy ; Neurology ; Quality of Health Care ; Thrombolytic Therapy ; Time Factors ; Treatment Outcome ; Vascular diseases and vascular malformations of the nervous system</subject><ispartof>Circulation (New York, N.Y.), 2006-01, Vol.113 (2), p.222-229</ispartof><rights>2006 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c330t-c75bc6ba75c56001c39eb086540ad72097a5e930d72e8a45e3fe820d383c9d063</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,3687,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17446217$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16401769$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>NALLAMOTHU, Brahmajee K</creatorcontrib><creatorcontrib>YONGFEI WANG</creatorcontrib><creatorcontrib>MAGID, David J</creatorcontrib><creatorcontrib>MCNAMARA, Robert L</creatorcontrib><creatorcontrib>HERRIN, Jeph</creatorcontrib><creatorcontrib>BRADLEY, Elizabeth H</creatorcontrib><creatorcontrib>BATES, Eric R</creatorcontrib><creatorcontrib>POLLACK, Charles V</creatorcontrib><creatorcontrib>KRUMHOLZ, Harlan M</creatorcontrib><creatorcontrib>National Registry of Myocardial Infarction Investigators</creatorcontrib><title>Relation between hospital specialization with primary percutaneous coronary intervention and clinical outcomes in ST-segment elevation myocardial infarction : National registry of myocardial infarction-4 analysis</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>Hospitals with primary percutaneous coronary intervention (PPCI) capability may choose to predominately offer PPCI to their patients with ST-segment elevation myocardial infarction (STEMI), or they may selectively offer PPCI or fibrinolytic therapy based on patient and hospital-level factors. Whether a greater level of hospital specialization with PPCI is associated with better quality of care is unknown.
We analyzed data from the National Registry of Myocardial Infarction-4 to compare in-hospital mortality and times to treatment in STEMI across different levels of hospital specialization with PPCI. We divided 463 hospitals into quartiles of PPCI specialization based on the relative proportion of reperfusion-treated patients who underwent PPCI (< or =34.0%, >34.0 to 62.5%, >62.5 to 88.5%, >88.5%). Hierarchical multivariable regression assessed whether PPCI specialization was associated with better outcomes, after adjusting for patient and hospital characteristics, including PPCI volume. We found that greater PPCI specialization was associated with a lower relative risk of in-hospital mortality in patients treated with PPCI (adjusted relative risk comparing the highest and lowest quartiles, 0.64; P=0.006) but not in those treated with fibrinolytic therapy. Compared with patients at hospitals in the lowest quartile of PPCI specialization, adjusted door-to-balloon times in the highest quartile were significantly shorter (99.6 versus 118.3 minutes; P<0.001), and the likelihood of door-to-balloon times exceeding 90 minutes was significantly lower (relative risk, 0.78; P<0.001). Adjusting for PPCI specialization diminished the association between PPCI volume and clinical outcomes.
Greater specialization with PPCI is associated with lower in-hospital mortality and shorter door-to-balloon times in STEMI patients treated with PPCI.</description><subject>Angioplasty, Balloon - mortality</subject><subject>Angioplasty, Balloon - statistics & numerical data</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Cardiology. Vascular system</subject><subject>Coronary heart disease</subject><subject>Data Collection</subject><subject>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</subject><subject>Electrocardiography</subject><subject>Emergency Medical Services</subject><subject>Female</subject><subject>Heart</subject><subject>Hospital Mortality</subject><subject>Hospitals, Special - standards</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - mortality</subject><subject>Myocardial Infarction - surgery</subject><subject>Myocardial Infarction - therapy</subject><subject>Neurology</subject><subject>Quality of Health Care</subject><subject>Thrombolytic Therapy</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Vascular diseases and vascular malformations of the nervous system</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNptkcFu1DAURS0EokPhF5BZwC6DHcdxzG40AjrSqJXKdB05zktr5MTBdloN39kPqjuJVCGxsn3f8bvSvQh9omRNaUm_bnfX25v95rC7utxcbNaU8DUXFZX8FVpRnhdZwZl8jVaEEJkJludn6F0Iv9OzZIK_RWe0LAgVpVyhx2uwKho34AbiA8CA71wYTVQWhxG0Udb8necPJt7h0Zte-SMewespqgHcFLB23g3Pqhki-HsYTrwaWqytGYxOu9wUteshJAT_OmQBbvuEYbBwP2_vj04r3ya_hHTK65P6DV-exkn1cGtCTCau-z-cFclS2WMw4T160ykb4MNynqObH98P24tsf_Vzt93sM80YiZkWvNFlowTXvCSEaiahIVXJC6JakRMpFAfJSLpDpQoOrIMqJy2rmJZtyvIcfZn3jt79mSDEujdBg7VzMLUgZQq5kgmUM6i9C8FDVy9B1pTUz5XW_1aaZF7Plaa_HxeTqemhffm5dJiAzwugQsq682rQJrxwoijKnAr2BBSBsv8</recordid><startdate>20060117</startdate><enddate>20060117</enddate><creator>NALLAMOTHU, Brahmajee K</creator><creator>YONGFEI WANG</creator><creator>MAGID, David J</creator><creator>MCNAMARA, Robert L</creator><creator>HERRIN, Jeph</creator><creator>BRADLEY, Elizabeth H</creator><creator>BATES, Eric R</creator><creator>POLLACK, Charles V</creator><creator>KRUMHOLZ, Harlan M</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20060117</creationdate><title>Relation between hospital specialization with primary percutaneous coronary intervention and clinical outcomes in ST-segment elevation myocardial infarction : National registry of myocardial infarction-4 analysis</title><author>NALLAMOTHU, Brahmajee K ; YONGFEI WANG ; MAGID, David J ; MCNAMARA, Robert L ; HERRIN, Jeph ; BRADLEY, Elizabeth H ; BATES, Eric R ; POLLACK, Charles V ; KRUMHOLZ, Harlan M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c330t-c75bc6ba75c56001c39eb086540ad72097a5e930d72e8a45e3fe820d383c9d063</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>Angioplasty, Balloon - mortality</topic><topic>Angioplasty, Balloon - statistics & numerical data</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Cardiology. Vascular system</topic><topic>Coronary heart disease</topic><topic>Data Collection</topic><topic>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</topic><topic>Electrocardiography</topic><topic>Emergency Medical Services</topic><topic>Female</topic><topic>Heart</topic><topic>Hospital Mortality</topic><topic>Hospitals, Special - standards</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - mortality</topic><topic>Myocardial Infarction - surgery</topic><topic>Myocardial Infarction - therapy</topic><topic>Neurology</topic><topic>Quality of Health Care</topic><topic>Thrombolytic Therapy</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Vascular diseases and vascular malformations of the nervous system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>NALLAMOTHU, Brahmajee K</creatorcontrib><creatorcontrib>YONGFEI WANG</creatorcontrib><creatorcontrib>MAGID, David J</creatorcontrib><creatorcontrib>MCNAMARA, Robert L</creatorcontrib><creatorcontrib>HERRIN, Jeph</creatorcontrib><creatorcontrib>BRADLEY, Elizabeth H</creatorcontrib><creatorcontrib>BATES, Eric R</creatorcontrib><creatorcontrib>POLLACK, Charles V</creatorcontrib><creatorcontrib>KRUMHOLZ, Harlan M</creatorcontrib><creatorcontrib>National Registry of Myocardial Infarction Investigators</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>NALLAMOTHU, Brahmajee K</au><au>YONGFEI WANG</au><au>MAGID, David J</au><au>MCNAMARA, Robert L</au><au>HERRIN, Jeph</au><au>BRADLEY, Elizabeth H</au><au>BATES, Eric R</au><au>POLLACK, Charles V</au><au>KRUMHOLZ, Harlan M</au><aucorp>National Registry of Myocardial Infarction Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Relation between hospital specialization with primary percutaneous coronary intervention and clinical outcomes in ST-segment elevation myocardial infarction : National registry of myocardial infarction-4 analysis</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2006-01-17</date><risdate>2006</risdate><volume>113</volume><issue>2</issue><spage>222</spage><epage>229</epage><pages>222-229</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><coden>CIRCAZ</coden><abstract>Hospitals with primary percutaneous coronary intervention (PPCI) capability may choose to predominately offer PPCI to their patients with ST-segment elevation myocardial infarction (STEMI), or they may selectively offer PPCI or fibrinolytic therapy based on patient and hospital-level factors. Whether a greater level of hospital specialization with PPCI is associated with better quality of care is unknown.
We analyzed data from the National Registry of Myocardial Infarction-4 to compare in-hospital mortality and times to treatment in STEMI across different levels of hospital specialization with PPCI. We divided 463 hospitals into quartiles of PPCI specialization based on the relative proportion of reperfusion-treated patients who underwent PPCI (< or =34.0%, >34.0 to 62.5%, >62.5 to 88.5%, >88.5%). Hierarchical multivariable regression assessed whether PPCI specialization was associated with better outcomes, after adjusting for patient and hospital characteristics, including PPCI volume. We found that greater PPCI specialization was associated with a lower relative risk of in-hospital mortality in patients treated with PPCI (adjusted relative risk comparing the highest and lowest quartiles, 0.64; P=0.006) but not in those treated with fibrinolytic therapy. Compared with patients at hospitals in the lowest quartile of PPCI specialization, adjusted door-to-balloon times in the highest quartile were significantly shorter (99.6 versus 118.3 minutes; P<0.001), and the likelihood of door-to-balloon times exceeding 90 minutes was significantly lower (relative risk, 0.78; P<0.001). Adjusting for PPCI specialization diminished the association between PPCI volume and clinical outcomes.
Greater specialization with PPCI is associated with lower in-hospital mortality and shorter door-to-balloon times in STEMI patients treated with PPCI.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>16401769</pmid><doi>10.1161/CIRCULATIONAHA.105.578195</doi><tpages>8</tpages></addata></record> |
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| ispartof | Circulation (New York, N.Y.), 2006-01, Vol.113 (2), p.222-229 |
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| source | MEDLINE; American Heart Association; Journals@Ovid Complete; EZB-FREE-00999 freely available EZB journals |
| subjects | Angioplasty, Balloon - mortality Angioplasty, Balloon - statistics & numerical data Biological and medical sciences Blood and lymphatic vessels Cardiology. Vascular system Coronary heart disease Data Collection Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Electrocardiography Emergency Medical Services Female Heart Hospital Mortality Hospitals, Special - standards Humans Male Medical sciences Middle Aged Myocardial Infarction - mortality Myocardial Infarction - surgery Myocardial Infarction - therapy Neurology Quality of Health Care Thrombolytic Therapy Time Factors Treatment Outcome Vascular diseases and vascular malformations of the nervous system |
| title | Relation between hospital specialization with primary percutaneous coronary intervention and clinical outcomes in ST-segment elevation myocardial infarction : National registry of myocardial infarction-4 analysis |
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