Regional system of care for ST-segment elevation myocardial infarction in the Northern Alps: a controlled pre- and postintervention study.
Arch Cardiovasc Dis
; 105(8-9): 414-23, 2012.
Article
en En
| MEDLINE
| ID: mdl-22958884
ABSTRACT
BACKGROUND:
Regionalization of care for ST-segment elevation myocardial infarction (STEMI) has been advocated, although its effect on processes of care and clinical outcomes remains uncertain.AIM:
To assess the impact of a regional system of care on provision of reperfusion therapy for STEMI patients relative to control hospitals.METHODS:
We analysed the original data from two nationwide prospective cohort studies conducted in 2000 and 2005, respectively. Overall, 160 hospitals participated in both studies, including seven hospitals involved in a regional system of care implemented in the Northern Alps in 2002 and 153 control hospitals located in other French areas.RESULTS:
A total of 102 and 2377 STEMI patients were enrolled in Northern Alps and control hospitals, respectively. Overall, patients enrolled in 2005 were more likely to receive any reperfusion therapy (60% vs 52%; P < 0.001), prehospital fibrinolysis (33% vs 15%; P < 0.001), and primary percutaneous coronary intervention (32% vs 26%; P < 0.001) than those enrolled in 2000. However, the regional system of care was associated with a larger absolute change in the use of prehospital fibrinolysis (45.0 vs 17.0; P = 0.02) and rescue or early routine coronary angiography or intervention after fibrinolysis (35.3 vs 15.2; P = 0.01). Patients enrolled in 2005 had lower adjusted hazard ratios for death (0.70, 95% confidence interval 0.57-0.87; P = 0.001), with no significant interaction between study groups.CONCLUSION:
Regionalization of care for STEMI patients improves access to reperfusion therapy, although its impact on clinical outcomes deserves further study.
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Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Programas Médicos Regionales
/
Reperfusión Miocárdica
/
Fibrinolíticos
/
Intervención Coronaria Percutánea
/
Infarto del Miocardio
Tipo de estudio:
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Risk_factors_studies
Límite:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
País/Región como asunto:
Europa
Idioma:
En
Revista:
Arch Cardiovasc Dis
Asunto de la revista:
ANGIOLOGIA
/
CARDIOLOGIA
Año:
2012
Tipo del documento:
Article
País de afiliación:
Francia