Summary
Health care outcome differences for patients first attended for ST-segment elevation myocardial infarction in Andalusian hospitals with or without a cardiac catheterization laboratory
Reina Toral A, Colmenero Ruiz M, García Pérez C, Expósito Ruiz M, De Antonio Martín E, Bermúdez Tamayo C, García Mochón L, Navarro Espigares JL, Hernández Torres E
Affiliation of the authors
Unidad de Cuidados Intensivos, Unidad para Apoyar la Investigación, Subdirección de Control de Gestión. Grupo de Investigación en Servicios de Salud, Hospital Universitario Virgen de las Nieves, Granada, Spain. Unidad de Cuidados Intensivos, Hospital Universitario San Cecilio, Granada, Spain. Subdirección de Control de Operaciones, Hospital Universitario Puerta del Mar, Cádiz, Spain. Escuela Andaluza de Salud Pública, Granada, Spain. Ciber de Epidemiología y Salud Pública. CIBERSP, Spain.
DOI
Quote
Reina Toral A, Colmenero Ruiz M, García Pérez C, Expósito Ruiz M, De Antonio Martín E, Bermúdez Tamayo C, et al. Health care outcome differences for patients first attended for ST-segment elevation myocardial infarction in Andalusian hospitals with or without a cardiac catheterization laboratory. Emergencias. 2014;26:101-8
Summary
Objective: To assess differences in care given to patients with ST-segment elevation
myocardial infarction (STEMI) in different hospitals with and without a cardiac
catheterization laboratory.
Methods: Retrospective cohort study of 11122 patients with STEMI attended in public
hospitals in Andalusia, Spain. Data for patients treated from 2005 to 2009 were
extracted from the ARIAM register (establised for the analysis of delays in care for acute
myocardial infarction). We analyzed patient characteristics, attending hospital,
reperfusion strategy used, complications during hospitalization, and mortality.
Results: Cardiac catheterization was available in hospitals attending 5728 patients
(51.5% of the total). This treatment approach was not available in hospitals where 5394
patients (48.5%) were treated. Of patients attended in hospitals with a catheterization
laboratory, 1891 (33.0%) underwent some type of percutaneous coronary intervention
and 2052 (35.8%) fibrinolysis. In hospitals without a catheterization laboratory, 349
patients (6.5%) underwent a percutaneous coronary intervention and 2665 (44.8%)
fibrinolysis (P<.001). Hospitals without a catheterization laboratory had significantly higher incidences of some complications (postinfarction angina, heart failure) and more readmissions. However, the hospitals with catheterization capability had higher rates of metabolic and infectious complications. Factors related to higher risk of death were age, female sex, diabetes, Killip classes III and IV, anterior location of infarction, and prolonged Q wave. Mortality was lower in hospitals with a catheterization laboratory (odds ratio, 0.748; 95% CI, 0.619-0.904). Conclusion: Health outcomes in patients with STEMI are better in hospitals where a cardiac catheterization laboratory is available. There are differences in both treatment approach and patient prognosis between hospitals with and without catheterization capability.