Patient outcomes after fibrinolytic therapy for acute myocardial infarction at hospitals with and without coronary revascularization capability
| Autor: | Rajendra H. Mehta, Eric R. Bates, Douglas A. Criger, Christopher B. Granger, Karen K. Pieper, Robert M. Califf, Eric J. Topol |
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| Rok vydání: | 2002 |
| Předmět: |
Male
Patient Transfer medicine.medical_specialty medicine.medical_treatment Streptokinase Myocardial Infarction Revascularization Fibrinolytic Agents Angioplasty Internal medicine Outcome Assessment Health Care Myocardial Revascularization medicine Humans Thrombolytic Therapy Myocardial infarction Aged Retrospective Studies Cardiac catheterization Aspirin business.industry Retrospective cohort study Middle Aged medicine.disease Survival Rate Coronary arteries medicine.anatomical_structure Tissue Plasminogen Activator Cardiology Female Cardiology Service Hospital Cardiology and Cardiovascular Medicine business medicine.drug |
| Zdroj: | Journal of the American College of Cardiology. 40:1034-1040 |
| ISSN: | 0735-1097 |
| Popis: | ObjectivesThis study evaluated clinical outcomes in patients with acute myocardial infarction (MI) treated with fibrinolytic therapy in hospitals with and without coronary revascularization capability.BackgroundPatients 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.MethodsWe 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.ResultsBaseline 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.ConclusionsPatients 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. |
| Databáze: | OpenAIRE |
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