| The volume of primary angioplasty procedures and survival after acute myocardial infarction. National Registry of Myocardial Infarction 2 Investigators. | |
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MedLine Citation:
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PMID: 10824077 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: There is an inverse relation between mortality from cardiovascular causes and the number of elective cardiac procedures (coronary angioplasty, stenting, or coronary bypass surgery) performed by individual practitioners or hospitals. However, it is not known whether patients with acute myocardial infarction fare better at centers where more patients undergo primary angioplasty or thrombolytic therapy than at centers with lower volumes. METHODS: We analyzed data from the National Registry of Myocardial Infarction to determine the relation between the number of patients receiving reperfusion therapy (primary angioplasty or thrombolytic therapy) and subsequent in-hospital mortality. A total of 450 hospitals were divided into quartiles according to the volume of primary angioplasty. Multiple logistic-regression models were used to determine whether the volume of primary angioplasty procedures was an independent predictor of in-hospital mortality among patients undergoing this procedure. Similar analyses were performed for patients receiving thrombolytic therapy at 516 hospitals. RESULTS: In-hospital mortality was 28 percent lower among patients who underwent primary angioplasty at hospitals with the highest volume than among those who underwent angioplasty at hospitals with the lowest volume (adjusted relative risk, 0.72; 95 percent confidence interval, 0.60 to 0.87; P<0.001). This lower rate, which represented 2.0 fewer deaths per 100 patients treated, was independent of the total volume of patients with myocardial infarction at each hospital, year of admission, and use or nonuse of adjunctive pharmacologic therapies. There was no significant relation between the volume of thrombolytic interventions and in-hospital mortality among patients who received thrombolytic therapy (7.0 percent for patients in the highest-volume hospitals vs. 6.9 percent for those in the lowest-volume hospitals, P=0.36). CONCLUSIONS: Among hospitals in the United States that have full interventional capabilities, a higher volume of angioplasty procedures is associated with a lower mortality rate among patients undergoing primary angioplasty, but there is no association between volume and mortality for thrombolytic therapy. |
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Authors:
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J G Canto; N R Every; D J Magid; W J Rogers; J A Malmgren; P D Frederick; W J French; A J Tiefenbrunn; V K Misra; C I Kiefe; H V Barron |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: The New England journal of medicine Volume: 342 ISSN: 0028-4793 ISO Abbreviation: N. Engl. J. Med. Publication Date: 2000 May |
Date Detail:
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Created Date: 2000-05-25 Completed Date: 2000-05-25 Revised Date: 2007-11-14 |
Medline Journal Info:
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Nlm Unique ID: 0255562 Medline TA: N Engl J Med Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1573-80 Citation Subset: AIM; IM |
Affiliation:
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Department of Medicine, and Center for Outcomes and Effectiveness Research and Education, University of Alabama at Birmingham, 35294-0012, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Angioplasty, Transluminal, Percutaneous Coronary
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mortality,
statistics & numerical data*,
utilization Hospital Mortality Humans Logistic Models Myocardial Infarction / drug therapy, mortality*, therapy Registries Risk Thrombolytic Therapy / mortality, statistics & numerical data*, utilization Time Factors United States / epidemiology |
| Grant Support | |
ID/Acronym/Agency:
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HS08843/HS/AHRQ HHS |
| Comments/Corrections | |
Comment In:
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N Engl J Med. 2000 Oct 5;343(14):1045
[PMID:
11023398
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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