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Trends in hospital treatments, including revascularisation, following acute myocardial infarction, 2003-2010: a multilevel and relative survival analysis for the National Institute for Cardiovascular Outcomes Research (NICOR).
Gale, C P; Allan, V; Cattle, B A; Hall, A S; West, R M; Timmis, A; Gray, H H; Deanfield, J; Fox, K A A; Feltbower, R.
Afiliação
  • Gale CP; Division of Epidemiology and Biostatistics, University of Leeds, , Leeds, UK.
Heart ; 100(7): 582-9, 2014 Apr.
Article em En | MEDLINE | ID: mdl-24436220
ABSTRACT

OBJECTIVE:

To investigate temporal changes in survival after acute myocardial infarction (AMI) by early invasive strategy.

METHODS:

Accelerated failure time and 6-month relative survival analyses stratified by thrombolysis or primary percutaneous coronary intervention (PPCI) for ST elevation myocardial infarction (STEMI) and coronary angiography for non-STEMI (NSTEMI) encompassing 583 466 patients across 247 hospitals in England and Wales over hospital admission periods 2003-2004, 2005-2006, 2007-2008 and 2009-2010.

RESULTS:

Survival improved significantly for STEMI patients who received reperfusion therapy (time ratio (TR) 1.47, 95% CI 1.22 to 2.78) and was stable for those who did not (TR 1.02, 95% CI 0.85 to 1.22). While there were significant improvements in survival for NSTEMI patients who underwent coronary angiography (TR 1.39, 95% CI 1.18 to 1.62), there was a significant decline for those who did not (TR 0.70, 95% CI 0.65 to 0.75). Patients without reperfusion therapy or coronary angiography had a greater number of comorbidities, but the use of secondary prevention medications was comparable with patients who received reperfusion therapy or coronary angiography. There was a significant hospital-level survival effect, with higher crude 6-month mortality in hospitals in the lowest coronary angiography and PPCI quartiles (angiography Q1 16.4% vs Q4 12.8%; PPCI Q1 15.8% vs Q4 12.4%).

CONCLUSIONS:

Survival rates after AMI have improved. Whereas survival estimates for STEMI patients who did not receive reperfusion therapy were stable, they worsened for NSTEMI patients not receiving coronary angiography.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Infarto do Miocárdio Limite: Adolescent / Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Heart Assunto da revista: CARDIOLOGIA Ano de publicação: 2014 Tipo de documento: Article País de afiliação: Reino Unido

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Infarto do Miocárdio Limite: Adolescent / Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Heart Assunto da revista: CARDIOLOGIA Ano de publicação: 2014 Tipo de documento: Article País de afiliação: Reino Unido