[Hospital resources and myocardial infarction case fatality. The IBERICA study].
OBJECTIVE
To determine the proportion of patients with myocardial infarction (MI) not admitted to a coronary care unit (CCU), the variables associated with admission into a CCU, and whether admission to a CCU, and the availability of coronary angiography in the same hospital, were associated with 28-day case fatality.


METHODS
Population-based registry of MI in patients 25 to 74 years of age, admitted during 1996-1998. Demographic and clinical characteristics were recorded, as well as management, clinical course and survival after 28 days. Hospitals were classified according to the availability of a CCU and catheterization laboratory (advanced hospital), CCU only (intermediate hospital) or neither (basic hospital). Admission to the CCU was also recorded.


RESULTS
In all, 9046 cases of MI were recorded; in 11.3% the patient was not admitted to a CCU. Age, smoking (OR=1.33; 95% CI, 1.08-1.64), non-Q MI (OR=0.62; 95% CI, 0.49-0.78) or undetermined location of MI (OR=0.34; 95% CI, 0.23-0.50), Killip 4 score on admission (OR=0.63; 95% CI, 0.40-1.00) and delay in arrival at the hospital >6 h were associated with CCU admission. Patients admitted to a CCU showed a lower case fatality in the first 24 h (4.2% vs 23.5%), which was independent of comorbidity, severity and treatment. The 24-hour survivors admitted to a basic hospital had higher case fatality (17.3% vs 7.8%) than other groups, which was related to differences in treatment.


CONCLUSIONS
CCU admission is associated with a lower case fatality in the first 24 h. Admission to a basic hospital is associated with a higher 28-day case fatality even in patients who survive 24 h.
Alvarez-León
Eva E
EE
Unitat de Lípids i Epidemiologia Cardiovascular, IMIM, Barcelona, España.
Elosua
Roberto
R
Zamora
Alberto
A
Aldasoro
Elena
E
Galcerá
José
J
Vanaclocha
Hermelinda
H
Segura
Antonio
A
Fiol
Miquel
M
Turumbay
Javier
J
Pérez
Gloria
G
Arteagoitia
José M
JM
Tormo
María J
MJ
Cabadés
Adolfo
A
Vega
Gema
G
Ayestarán
José I
JI
García
Vega
V
Hurtado-de-Saracho
Iraida
I
Navarro
Carmen
C
Zurriaga
Oscar
O
Muñiz
Javier
J
Sala
Joan
J
Marrugat
Jaume
J
D000328:Adult; D000368:Aged; D016507:Cardiology Service, Hospital / Q000706:statistics & numerical data; D002317:Cardiovascular Agents / Q000627:therapeutic use; D003325:Coronary Care Units / Q000706:statistics & numerical data*; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006334:Heart Function Tests / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality* / Q000628:therapy; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology
D002317:Cardiovascular Agents