title: Quality of care for myocardial infarction at academic and nonacademic hospitals.
abstract: BACKGROUND
  Whether academic hospitals provide better quality of care for patients with acute myocardial infarction is widely debated. The aim of this study was to compare processes of care and mortality between academic and nonacademic hospitals in the contemporary era of acute myocardial infarction management.
  
  
  METHODS
  We analyzed the original data from a prospective cohort study of 3059 patients, including 1714 with ST-segment elevation and 1345 with non-ST-segment elevation myocardial infarction, enrolled at 39 and 183 academic and nonacademic hospitals, respectively, in France.
  
  
  RESULTS
  Unadjusted 1-year mortality for academic and nonacademic hospitals was 10% versus 15% for patients with ST-segment elevation myocardial infarction (P=.01) and 13% versus 14% for patients with non-ST-segment elevation myocardial infarction (P=.75). Patients treated in academic or nonacademic hospitals with percutaneous coronary intervention capability were more likely to receive reperfusion and recommended drug therapies than those treated in nonacademic hospitals without percutaneous coronary intervention capability. After adjusting for baseline characteristics, the hazards of death associated with admission to nonacademic hospitals with and without percutaneous coronary intervention capability relative to academic hospitals were 1.13 (95% confidence interval [CI], 0.79-1.62) and 1.65 (95% CI, 1.09-2.49) for those with ST-segment elevation myocardial infarction and 0.95 (95% CI, 0.66-1.36) and 1.06 (95% CI, 0.72-1.58) for those with non-ST-segment elevation myocardial infarction, respectively. Further adjustment for receipt of acute reperfusion and recommended drug therapies eliminated all differences in mortality between the study groups.
  
  
  CONCLUSIONS
  Admission to academic hospitals was associated with a more frequent use of recommended therapies, conveying a survival advantage for patients with ST-segment elevation myocardial infarction.
authors.affiliation: Department of Cardiology, Annecy General Hospital, France.
authors.forename: Loic
authors.initials: L
authors.lastname: Belle
authors.forename: José
authors.initials: J
authors.lastname: Labarère
authors.forename: Magali
authors.initials: M
authors.lastname: Fourny
authors.forename: Elodie
authors.initials: E
authors.lastname: Drouet
authors.forename: Geneviève
authors.initials: G
authors.lastname: Mulak
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Dujardin
authors.forename: Didier
authors.initials: D
authors.lastname: Vilarem
authors.forename: Philippe
authors.initials: P
authors.lastname: Bonnet
authors.forename: Michel
authors.initials: M
authors.lastname: Hanssen
authors.forename: Tabassome
authors.initials: T
authors.lastname: Simon
authors.forename: Jean
authors.initials: J
authors.lastname: Ferrières
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danchin
mesh_terms: D000046:Academic Medical Centers / Q000592:standards*; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006761:Hospitals / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D013663:Teaching / Q000706:statistics & numerical data*