STEMI mortality in community hospitals versus PCI-capable hospitals: results from a nationwide STEMI network programme.
OBJECTIVE
Reports examining local ST elevation myocardial infarction (STEMI) networks focused mainly on percutaneous coronary intervention (PCI)-related time issues and outcomes. To validate the concept of STEMI networks in a real-world context, more data are needed on management and outcome of an unselected community based STEMI population.


RESULTS
The current study evaluated reperfusion strategies and in-hospital mortality in 8500 unselected STEMI patients admitted to 47 community hospitals (n=3053) and 25 PCI-capable hospitals (n=5447) in the context of a nationwide STEMI network programme that started in 2007 in Belgium. The distance between the hub and spoke hospitals ranged from 2.2 to 47 km (median 15 km). A propensity score was used to adjust for differences in baseline characteristics. Reperfusion strategy was significantly different with a predominant use of primary PCI (pPCI) in PCI-capable hospitals (93%), compared to a mixed use of pPCI (71%) and thrombolysis (20%) in community hospitals. A door-to-balloon time <120 min was achieved in 83% of community hospitals and in 91% of PCI-capable hospitals (p<0.0001). In-hospital mortality was 7.0% in community hospitals versus 6.7% in PCI-capable hospitals with an adjusted odds ratio of 1.1 (95% confidence interval: 0.8-1.4). Between the periods 2007-2008 and 2009-2010, the pPCI rate in community hospitals increased from 60% to 80%, whereas the proportion of conservatively managed patients decreased from 11.1% to 7.9%.


CONCLUSIONS
In a STEMI network with >70% use of pPCI, in-hospital mortality was comparable between community hospitals and PCI-capable hospitals. Participation in the STEMI network programme was associated with an increased adherence to reperfusion guidelines over time.
University Hospital Antwerp, Edegem, Belgium.
Marc J
MJ
Claeys
Peter R
PR
Sinnaeve
Carl
C
Convens
Philippe
P
Dubois
Jean
J
Boland
Pascal
P
Vranckx
Sofie
S
Gevaert
Antoine
A
de Meester
Patrick
P
Coussement
Herbert
H
De Raedt
Christophe
C
Beauloye
Marc
M
Renard
Christiaan
C
Vrints
Patrick
P
Evrard
ST elevation myocardial infarction; networks; primary PCI