title: Comparability of quality-of-care indicators for emergency coronary angioplasty in patients with acute myocardial infarction regardless of on-site cardiac surgery (report from the National Registry of Myocardial Infarction).
abstract: Initial reports have suggested that primary percutaneous coronary intervention (PCI) can be performed safely in selected hospitals without on-site cardiac surgery; however, quality-of-care indicators for primary PCI in these institutions is unknown. Therefore, symptom onset-to-door intervals, door-to-balloon times, compliance with American College of Cardiology/American Heart Association (ACC/AHA) management guidelines, and in-hospital mortality were evaluated in 108,132 patients in 3 hospital settings in the National Registry of Myocardial Infarction: (1) diagnostic laboratories only (n = 47), (2) elective PCI only (n = 50), and (3) elective PCI and cardiac surgery (n = 562). Mean symptom onset-to-door intervals (127 minutes, 95% confidence interval 118 to135; 134 minutes, 95% confidence interval 125 to 142; and 140 minutes, 95% confidence intervals 138 to 141; p = 0.01) and door-to-balloon intervals (104 minutes, 95% confidence interval 101 to 108; 116 minutes, 95% confidence interval 112 to 119; and 119 minutes, 95% confidence interval 118 to 120; p <0.0001) were shorter in hospitals without cardiac surgery. Adherence to ACC/AHA guidelines for medications within the first 24 hours (aspirin, beta blockers, angiotensin-converting enzyme inhibitors) was greater in hospitals without cardiac surgery. There were comparable in-hospital mortality rates (3.2%, 4.2%, and 4.8%, respectively; p = 0.07) for patients with similar Thrombolysis In Myocardial Infarction risk scores; however, 4.7% of patients treated with primary PCI in hospitals without cardiac surgery were transferred to another institution. Thus, hospitals performing primary PCI without on-site cardiac surgery that participated in this registry have quality-of-care indicators and adherence to ACC/AHA management guidelines that are comparable to hospitals with on-site cardiac surgery. The lack of on-site cardiac surgery does not appear to adversely affect quality-of-care indicators in primary PCI.
authors.affiliation: Feinberg School of Medicine, Northwestern University, Evanston Northwestern Healthcare, Burch 300, 2650 Ridge Avenue, Evanston, IL 60201, USA. tsanborn@enh.org
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Sanborn
authors.forename: Alice K
authors.initials: AK
authors.lastname: Jacobs
authors.forename: Paul D
authors.initials: PD
authors.lastname: Frederick
authors.forename: Nathan R
authors.initials: NR
authors.lastname: Every
authors.forename: William J
authors.initials: WJ
authors.lastname: French
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D003430:Cross-Sectional Studies; D004638:Emergency Treatment; D005260:Female; D019983:Guideline Adherence; D017052:Hospital Mortality; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D011787:Quality of Health Care; D012042:Registries / Q000706:statistics & numerical data*; D012306:Risk; D013503:Surgery Department, Hospital; D015912:Thrombolytic Therapy; D013997:Time Factors