[No advantage to referring patients with acute myocardial infarction from a general hospital to an intervention clinic for percutaneous coronary intervention; comparison of mortality rates in 2000 and 2003 in the Meander Medical Centre, Amersfoort].
OBJECTIVE
To evaluate whether implementation of the 2000 Netherlands Society of Cardiology guideline 'ST-elevation acute coronary syndromes', which recommends the use ofpercutaneous coronary intervention (PCI), has reduced mortality and complication rates in a general hospital, and whether patient characteristics and outcomes are comparable to those reported in the Assessment of the Safety and Efficacy of a New Thrombolytic (ASSENT) 2 and 3 trials.


METHODS
Retrospective outcomes study.


METHODS
Data from 2003 were compared with data from 2000 regarding patients with acute myocardial infarction who received thrombolysis at the Meander Medical Centre in Amersfoort, the Netherlands, or percutaneous transluminal coronary angioplasty (PTCA) after referral to an intervention clinic. Data included baseline characteristics, type of treatment, outcomes and complications. Age, sex and mortality ofall patients were compared to data from the ASSENT 2 and 3 trials.


RESULTS
Data were included from 130/132 patients treated in 2003 and 145/145 patients treated in 2000. Baseline characteristics were comparable, except age: there were significant more elderly patients in 2003 (p = 0.006). After implementation of the guideline, significantly more patients underwent PTCA (odds ratio (OR) 4.41 (95% CI: 2.51-7.75)). After adjusting for confounding factors there was no significant difference in in-hospital mortality (adjusted OR 1.11 (95% CI: 0.48-2.60)), 30-day mortality and 1-year mortality. Significantly more minor complications were reported (OR 2.58 (95% CI: 1.07-6.19)). Significantly more women and patients older than 75 years were treated compared with the ASSENT 2 and 3 trials. The 30-day mortality rate was significantly higher compared with ASSENT 2 (OR 1.60 (95% CI: 1.07-2.41)) and ASSENT 3 (OR1.74 (95% CI: 1.14-2.66)).


CONCLUSIONS
The implementation of new guidelines 'ST-elevation acute coronary syndromes' did not result in lower mortality or fewer complications.
Tabbers
F C A
FC
Meander Medisch Centrum, Amersfoort. f.tabbers@slingeland.nl
Nagtegaal
J E
JE
Landman
M A J
MA
van der Westerlaken
M M L
MM
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D005260:Female; D017052:Hospital Mortality; D006769:Hospitals, General / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality* / Q000628:therapy; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D016019:Survival Analysis; D015996:Survival Rate; D015912:Thrombolytic Therapy / Q000379:methods; D016896:Treatment Outcome