title: Regional system of care for ST-segment elevation myocardial infarction in the Northern Alps: a controlled pre- and postintervention study.
abstract: BACKGROUND
  Regionalization of care for ST-segment elevation myocardial infarction (STEMI) has been advocated, although its effect on processes of care and clinical outcomes remains uncertain.
  
  
  OBJECTIVE
  To assess the impact of a regional system of care on provision of reperfusion therapy for STEMI patients relative to control hospitals.
  
  
  METHODS
  We analysed the original data from two nationwide prospective cohort studies conducted in 2000 and 2005, respectively. Overall, 160 hospitals participated in both studies, including seven hospitals involved in a regional system of care implemented in the Northern Alps in 2002 and 153 control hospitals located in other French areas.
  
  
  RESULTS
  A total of 102 and 2377 STEMI patients were enrolled in Northern Alps and control hospitals, respectively. Overall, patients enrolled in 2005 were more likely to receive any reperfusion therapy (60% vs 52%; P < 0.001), prehospital fibrinolysis (33% vs 15%; P < 0.001), and primary percutaneous coronary intervention (32% vs 26%; P < 0.001) than those enrolled in 2000. However, the regional system of care was associated with a larger absolute change in the use of prehospital fibrinolysis (45.0 vs 17.0; P = 0.02) and rescue or early routine coronary angiography or intervention after fibrinolysis (35.3 vs 15.2; P = 0.01). Patients enrolled in 2005 had lower adjusted hazard ratios for death (0.70, 95% confidence interval 0.57-0.87; P = 0.001), with no significant interaction between study groups.
  
  
  CONCLUSIONS
  Regionalization of care for STEMI patients improves access to reperfusion therapy, although its impact on clinical outcomes deserves further study.
authors.affiliation: Quality of Care Unit, Grenoble University Hospital, Grenoble, France. jlabarere@chu-grenoble.fr
authors.forename: José
authors.initials: J
authors.lastname: Labarère
authors.forename: Loic
authors.initials: L
authors.lastname: Belle
authors.forename: Magali
authors.initials: M
authors.lastname: Fourny
authors.forename: Gérald
authors.initials: G
authors.lastname: Vanzetto
authors.forename: Guillaume
authors.initials: G
authors.lastname: Debaty
authors.forename: David
authors.initials: D
authors.lastname: Delgado
authors.forename: Julien
authors.initials: J
authors.lastname: Brallet
authors.forename: Benoît
authors.initials: B
authors.lastname: Vallet
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danchin
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D017023:Coronary Angiography / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005602:France / Q000453:epidemiology; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000628:therapy*; D015425:Myocardial Reperfusion; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data*; D012041:Regional Medical Programs; D012189:Retrospective Studies
chemical_list: D005343:Fibrinolytic Agents