Better outcomes for acute myocardial infarction patients first admitted to PCI hospitals in Estonia

Abstract

Objective – The objective of this study was to compare process of care, in-hospital outcomes, and 1-year mortality of patients with acute myocardial infarction (AMI) first admitted to hospitals with and without percutaneous coronary intervention (PCI) facilities in Estonia in 2007.Methods – We conducted a retrospective cross-sectional study on a random sample of hospitalized AMI patients. Data on process of care and in-hospital outcomes were abstracted from patient records in 16 hospitals according to a standardized study form.Results – Patients first admitted to PCI hospitals (n88=88327) had higher rates of overall use of coronary angiography (78.3% vs. 24.7%; P 88<880.001), revascularization (64.2% vs. 20.6%; P 88<880.001), and echocardiography (85.3% vs. 65.3%, P 88<880.001) than those first admitted to non-PCI hospitals (n88=88360). Among the non-PCI hospital patients those selected for cardiac catheterization were younger, healthier, and had better clinical status on presentation. Patients admitted to PCI hospitals had higher prescription rates of in-hospital and discharge evidence-based medications except for beta-blockers. PCI hospitals’ patients had lower in-hospital mortality (11.3% vs. 19.2%, P 88=880.004) and 1-year mortality (24.5% vs. 34.7%, P 88=880.003), results remained significant after adjustment for baseline characteristics (odds ratio 0.47; 95% confidence interval 0.28-0.78, hazard ratio 0.66; 95% confidence interval 0.48-0.90).Conclusions – There are disparities in process of care, in-hospital and 1-year mortality between patients first admitted to PCI vs. non-PCI hospitals in Estonia. Patients admitted to non-PCI hospitals should undergo more vigorous risk stratification using invasive and non-invasive methods; use of evidence-based medicine should be encouraged even if cardiac revascularization is not done.