Outcomes among patients with ST-segment-elevation myocardial infarction presenting to interventional hospitals with and without on-site cardiac surgery

Abstract

Background: Primary percutaneous coronary intervention (pPCI) is the preferred reperfusion strategy for patients with ST-segment-elevation myocardial infarction (STEMI). The quality of care and safety and efficacy of pPCI at hospitals without on-site open heart surgery (No-OHS hospitals) remains an area of active investigation.

Methods and results: The National Registry of Myocardial Infarction enrolled 58 821 STEMI patients from 214 OHS hospitals (n=54 076) and 52 No-OHS hospitals (n=4745) with PCI capabilities from 2004 to 2006. Patients presenting to OHS hospitals had substantially lower in-hospital mortality (7.0% versus 9.8%, P<0.001) and were more likely to receive any form of acute reperfusion therapy (80.8% versus 70.8%, P<0.001). Patients who presented to OHS hospitals were more likely to receive guideline recommended medications within 24 hours of arrival. In a propensity score model matching for patient characteristics and transfer status, in-hospital mortality remained significantly lower among patients presenting to OHS hospitals (7.2% versus 9.3%, P=0.025). When this model was further adjusted for differences in the use of acute reperfusion therapy, medications administered within 24 hours and hospital characteristics, the mortality difference was of borderline significance (hazard ratio, 0.87; 95% CI, 0.75 to 1.01; P=0.067). When the propensity score analysis was restricted to patients who underwent pPCI, there was no significant difference in mortality (3.8% versus 3.3%, P=0.44).

Conclusions: STEMI patients presenting to No-OHS hospitals have substantially higher mortality, are less likely to receive guideline recommended medications within 24 hours, and are less likely to undergo acute reperfusion therapy, although this difference was of borderline significance after adjusting for hospital and treatment variables. There was no difference in mortality among patients undergoing pPCI.