Impact on Mortality of Different Network Systems in the Treatment of ST-segment Elevation Acute Myocardial Infarction. The Spanish Experience.

Abstract

INTRODUCTION AND OBJECTIVES:

To analyze the association between the development of network systems of care for ST-segment elevation myocardial infarction (STEMI) in the autonomous communities (AC) of Spain and the regional rate of percutaneous coronary intervention (PCI) and in-hospital mortality.

METHODS:

From 2003 to 2012, data from the minimum basic data set of the Spanish taxpayer-funded health system were analyzed, including admissions from general hospitals. Diagnoses of STEMI and related procedures were codified by the International Diseases Classification. Discharge episodes (n = 302 471) were distributed in 3 groups: PCI (n = 116 621), thrombolysis (n = 46 720), or no reperfusion (n = 139 130).

RESULTS:

Crude mortality throughout the evaluation period was higher for the no-PCI or thrombolysis group (17.3%) than for PCI (4.8%) and thrombolysis (8.6%) (P < .001). For the aggregate of all communities, the PCI rate increased (21.6% in 2003 vs 54.5% in 2012; P < .001) with a decrease in risk-standardized mortality rates (10.2% in 2003; 6.8% in 2012; P < .001). Significant differences were observed in the PCI rate across the AC. The development of network systems was associated with a 50% increase in the PCI rate (P < .001) and a 14% decrease in risk-standardized mortality rates (P < .001).

CONCLUSIONS:

From 2003 to 2012, the PCI rate in STEMI substantially increased in Spain. The development of network systems was associated with an increase in the PCI rate and a decrease in in-hospital mortality.

• Authors: Ángel Cequier, Albert Ariza-Solé, Francisco J Elola, Cristina Fernández-Pérez, José L Bernal, José V Segura, Andrés Iñiguez, Vicente Bertomeu
• Journal: Revista espanola de cardiologia (English ed.) (Rev Esp Cardiol (Engl Ed)) Vol. 70 Issue 3 Pg. 155-161 (Mar 2017) ISSN: 1885-5857 [Electronic] Spain
• PMID: 27600863 (Publication Type: Journal Article, Observational Study)
• Copyright: Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Topics

• Aged
• Analysis of Variance
• Female
• Hospital Mortality
• Humans
• Male
• Myocardial Reperfusion (mortality, statistics & numerical data, trends)
• Percutaneous Coronary Intervention (mortality, statistics & numerical data, trends)
• Risk Assessment
• ST Elevation Myocardial Infarction (mortality, therapy)
• Spain (epidemiology)
• State Medicine
• Survival Rate
• Thrombolytic Therapy (mortality, statistics & numerical data, trends)