title: Trends in hospital treatments, including revascularisation, following acute myocardial infarction, 2003-2010: a multilevel and relative survival analysis for the National Institute for Cardiovascular Outcomes Research (NICOR).
abstract: OBJECTIVE
  To investigate temporal changes in survival after acute myocardial infarction (AMI) by early invasive strategy.
  
  
  METHODS
  Accelerated failure time and 6-month relative survival analyses stratified by thrombolysis or primary percutaneous coronary intervention (PPCI) for ST elevation myocardial infarction (STEMI) and coronary angiography for non-STEMI (NSTEMI) encompassing 583 466 patients across 247 hospitals in England and Wales over hospital admission periods 2003-2004, 2005-2006, 2007-2008 and 2009-2010.
  
  
  RESULTS
  Survival improved significantly for STEMI patients who received reperfusion therapy (time ratio (TR) 1.47, 95% CI 1.22 to 2.78) and was stable for those who did not (TR 1.02, 95% CI 0.85 to 1.22). While there were significant improvements in survival for NSTEMI patients who underwent coronary angiography (TR 1.39, 95% CI 1.18 to 1.62), there was a significant decline for those who did not (TR 0.70, 95% CI 0.65 to 0.75). Patients without reperfusion therapy or coronary angiography had a greater number of comorbidities, but the use of secondary prevention medications was comparable with patients who received reperfusion therapy or coronary angiography. There was a significant hospital-level survival effect, with higher crude 6-month mortality in hospitals in the lowest coronary angiography and PPCI quartiles (angiography Q1: 16.4% vs Q4: 12.8%; PPCI Q1: 15.8% vs Q4: 12.4%).
  
  
  CONCLUSIONS
  Survival rates after AMI have improved. Whereas survival estimates for STEMI patients who did not receive reperfusion therapy were stable, they worsened for NSTEMI patients not receiving coronary angiography.
authors.affiliation: Division of Epidemiology and Biostatistics, University of Leeds, , Leeds, UK.
authors.forename: C P
authors.initials: CP
authors.lastname: Gale
authors.forename: V
authors.initials: V
authors.lastname: Allan
authors.forename: B A
authors.initials: BA
authors.lastname: Cattle
authors.forename: A S
authors.initials: AS
authors.lastname: Hall
authors.forename: R M
authors.initials: RM
authors.lastname: West
authors.forename: A
authors.initials: A
authors.lastname: Timmis
authors.forename: H H
authors.initials: HH
authors.lastname: Gray
authors.forename: J
authors.initials: J
authors.lastname: Deanfield
authors.forename: K A A
authors.initials: KA
authors.lastname: Fox
authors.forename: R
authors.initials: R
authors.lastname: Feltbower
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D062645:Percutaneous Coronary Intervention; D016019:Survival Analysis; D013997:Time Factors; D055815:Young Adult
keywords: Hospital treatments; Myocardial infarction; Revascularisation; Survival; Temporal changes