Impact on Mortality of Different Network Systems in the Treatment of ST-segment Elevation Acute Myocardial Infarction. The Spanish Experience
Por:
Cequier Á, Ariza-Solé A, Elola FJ, Fernández-Pérez C, Bernal JL, Segura JV, Iñiguez A and Bertomeu V
Publicada:
1 mar 2017
Categoría:
Medicine (miscellaneous)
Resumen:
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 riskstandardized 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. (C) 2016 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.
Filiaciones:
Cequier Á:
Sociedad Española de Cardiología, Madrid, Spain
Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge, IDIBELL, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
Ariza-Solé A:
Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge, IDIBELL, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
Elola FJ:
Sociedad Española de Cardiología, Madrid, Spain
Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
Fernández-Pérez C:
Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
Bernal JL:
Servicio de Control de Gestión, Hospital 12 de Octubre, Madrid, Spain
Segura JV:
Centro de Investigación Operativa, Instituto Universitario de Investigación (IUI), Universidad Miguel Hernández, Alicante, Spain
Iñiguez A:
Sociedad Española de Cardiología, Madrid, Spain
Servicio de Cardiología, Hospital Álvaro Cunquerio, Vigo, Pontevedra, Spain
:
Sociedad Española de Cardiología, Madrid, Spain
Servicio de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain
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