title: Outcomes of myocardial infarction in hospitals with percutaneous coronary intervention facilities.
abstract: BACKGROUND
  Despite evidence on the efficacy and safety of percutaneous coronary intervention (PCI) for patients with acute myocardial infarction, it is unclear whether patients admitted to hospitals with on-site PCI facilities (herein after, PCI hospitals) have improved outcomes in routine practice.
  
  
  METHODS
  We compared processes of care, hospital outcomes, and 1-year mortality rate for 1176 consecutive patients admitted to 126 PCI hospitals and 738 patients admitted to 190 non-PCI hospitals in France from November 1 to November 30, 2000.
  
  
  RESULTS
  Patients admitted to PCI hospitals were more likely to receive evidence-based acute (within 48 hours of admission) and discharge medications and to undergo PCI within 48 hours of admission than those admitted to non-PCI hospitals (54% vs 6.2%; P<.001). Despite comparable rates of in-hospital stroke (0.9% vs 1.1%; P=.75) and reinfarction (1.7% vs 2.5%; P=.25), patients admitted to PCI vs non-PCI hospitals had lower in-hospital (7.5% vs 12%; P=.001) and 1-year (13% vs 20%; P<.001) mortality rates. Admission to PCI hospitals was associated with decreased hazard ratios of mortality after adjusting for baseline characteristics (0.75; 95% confidence interval, 0.57-0.98) or propensity score (0.76; 95% confidence interval, 0.59-0.97). Most of the survival benefit of admission to a PCI hospital was explained by the use of PCI and evidence-based discharge medications.
  
  
  CONCLUSIONS
  In this prospective observational study, admission of patients with acute myocardial infarction to PCI hospitals was associated with greater use of PCI and evidence-based medications and with improved 1-year survival. Although we cannot exclude the possibility that some unmeasured confounding factors might explain the survival benefit of admission to PCI hospitals, our findings support routine use of PCI and evidence-based medications for these patients.
authors.affiliation: Techniques pour l'Evaluation et la Modélisation des Actions de Santé, Centre Hospitalier Universitaire, Grenoble, France. JLabarere@chu-grenoble.fr
authors.forename: Jose
authors.initials: J
authors.lastname: Labarere
authors.forename: Loic
authors.initials: L
authors.lastname: Belle
authors.forename: Magali
authors.initials: M
authors.lastname: Fourny
authors.forename: Nathalie
authors.initials: N
authors.lastname: Genès
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Lablanche
authors.forename: Didier
authors.initials: D
authors.lastname: Blanchard
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Cambou
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danchin
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D016507:Cardiology Service, Hospital; D015331:Cohort Studies; D005260:Female; D005602:France; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D015996:Survival Rate