Title of article :
Patient outcomes after fibrinolytic therapy for acute myocardial infarction at hospitals with and without coronary revascularization capability
Author/Authors :
Rajendra H. Mehta، نويسنده , , Douglas A. Criger، نويسنده , , Christopher B. Granger، نويسنده , , Karen K. Pieper، نويسنده , , Robert M. Califf، نويسنده , , Eric J. Topol، نويسنده , , Eric R. Bates، نويسنده ,
Issue Information :
روزنامه با شماره پیاپی سال 2002
Abstract :
Objectives
This study evaluated clinical outcomes in patients with acute myocardial infarction (MI) treated with fibrinolytic therapy in hospitals with and without coronary revascularization capability.
Background
Patients with MI may have better outcomes when admitted to certain hospitals with coronary revascularization capability. Development of regional heart care centers for the treatment of MI has been proposed.
Methods
We performed a retrospective analysis of 25,515 U.S. patients enrolled in the Global Use of Streptokinase and TPA (alteplase) for Occluded Coronary arteries (GUSTO)-I trial. Outcomes of patients admitted to hospitals with and without coronary revascularization capability were analyzed. We also analyzed patients who remained in hospitals without coronary revascularization capability compared with those transferred to hospitals with revascularization capability.
Results
Baseline characteristics and complications were similar between patients in the two hospital types. Patients in hospitals with coronary revascularization capability more often underwent cardiac catheterization (78.1% vs. 59.2%; p < 0.001), angioplasty (34.6% vs. 22.6%; p < 0.001), or bypass surgery (14.1% vs. 10.4%; p < 0.001) but had a similar adjusted 30-day (odds ratio [OR] 0.91, 95% confidence interval [CI] 82 to 1.02) and one-year (OR 0.98, 95% CI 0.90 to 1.07) mortality. Forty percent of patients admitted to hospitals without revascularization capability were transferred, with 94% of transfer patients undergoing angiography. Almost 80% of transfers occurred >48 h after hospital admission.
Conclusions
Patients receiving fibrinolytic therapy for acute MI admitted to hospitals without coronary revascularization capability appear to have outcomes similar to those of patients admitted to hospitals with such capability when aspirin and beta-adrenergic blocking agents are given appropriately and transfer is available for angiography and angioplasty as needed.
Keywords :
CABG , coronary artery bypass grafting , Confidence interval , CI , GUSTO-I , GUSTO-IIb , MI , NRMI , Global Use of Strategies to Open Occluded Arteries in Acute Coronary Syndromes , National Registry of Myocardial Infarction , odds ratio , ACE , PTCA , OR , Global Utilization of Streptokinase and TPA (alteplase) for Occluded Coronary Arteries , myocardial infarction , angiotensin-converting enzyme , percutaneous transluminal coronary angioplasty
Journal title :
JACC (Journal of the American College of Cardiology)
Journal title :
JACC (Journal of the American College of Cardiology)