Association of hospital primary angioplasty volume in ST-segment elevation myocardial infarction with quality and outcomes

JAMA : the Journal of the American Medical Association
Dharam J KumbhaniGet With the Guidelines Steering Committee and Investigators

Abstract

Earlier studies indicate an inverse relationship between hospital volume and mortality after primary angioplasty for patients presenting with ST-segment elevation myocardial infarction (STEMI). However, contemporary data are lacking. To assess the relationship between hospital primary angioplasty volume and outcomes and quality of care measures in patients presenting with STEMI. An observational analysis of data on 29,513 patients presenting with STEMI and undergoing primary angioplasty in the American Heart Association's Get With the Guidelines registry. Patients were treated between July 5, 2001, and December 31, 2007, at 166 angioplasty-capable hospitals across the United States. Hospitals were divided into tertiles (<36 procedures per year, 36-70 procedures per year, and >70 procedures per year) based on their annual primary angioplasty volume. Door-to-balloon (DTB) times, length of hospital stay, adherence with evidence-based quality of care measures, and in-hospital mortality. Compared with low- and medium-volume centers, high-volume centers had better median DTB times (98 vs 90 vs 88 minutes, respectively; P for trend < .001). High-volume centers were more likely than low-volume centers to follow evidence-based guideline...Continue Reading

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