Impact on Mortality of Different Network Systems in the Treatment of ST-segment Elevation Acute Myocardial Infarction. The Spanish Experience.
OBJECTIVE
To analyze the association between the development of network systems of care for ST-segment elevation myocardial infarction (STEMI) in the autonomous communities (AC) of Spain and the regional rate of percutaneous coronary intervention (PCI) and in-hospital mortality.


METHODS
From 2003 to 2012, data from the minimum basic data set of the Spanish taxpayer-funded health system were analyzed, including admissions from general hospitals. Diagnoses of STEMI and related procedures were codified by the International Diseases Classification. Discharge episodes (n = 302 471) were distributed in 3 groups: PCI (n = 116 621), thrombolysis (n = 46 720), or no reperfusion (n = 139 130).


RESULTS
Crude mortality throughout the evaluation period was higher for the no-PCI or thrombolysis group (17.3%) than for PCI (4.8%) and thrombolysis (8.6%) (P < .001). For the aggregate of all communities, the PCI rate increased (21.6% in 2003 vs 54.5% in 2012; P < .001) with a decrease in risk-standardized mortality rates (10.2% in 2003; 6.8% in 2012; P < .001). Significant differences were observed in the PCI rate across the AC. The development of network systems was associated with a 50% increase in the PCI rate (P < .001) and a 14% decrease in risk-standardized mortality rates (P < .001).


CONCLUSIONS
From 2003 to 2012, the PCI rate in STEMI substantially increased in Spain. The development of network systems was associated with an increase in the PCI rate and a decrease in in-hospital mortality.
Sociedad Española de Cardiología, Madrid, Spain; Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge, IDIBELL, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. Electronic address: acequier@bellvitgehospital.cat.
Ángel
Á
Cequier
Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge, IDIBELL, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
Albert
A
Ariza-Solé
Sociedad Española de Cardiología, Madrid, Spain; Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain.
Francisco J
FJ
Elola
Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain.
Cristina
C
Fernández-Pérez
Servicio de Control de Gestión, Hospital 12 de Octubre, Madrid, Spain.
José L
JL
Bernal
Centro de Investigación Operativa, Instituto Universitario de Investigación (IUI), Universidad Miguel Hernández, Alicante, Spain.
José V
JV
Segura
Sociedad Española de Cardiología, Madrid, Spain; Servicio de Cardiología, Hospital Álvaro Cunquerio, Vigo, Pontevedra, Spain.
Andrés
A
Iñiguez
Sociedad Española de Cardiología, Madrid, Spain; Servicio de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain.
Vicente
V
Bertomeu
D000368:Aged; D000704:Analysis of Variance; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D015425:Myocardial Reperfusion / Q000401:mortality / Q000706:statistics & numerical data / Q000639:trends; D062645:Percutaneous Coronary Intervention / Q000401:mortality / Q000706:statistics & numerical data* / Q000639:trends; D018570:Risk Assessment; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D013030:Spain / Q000453:epidemiology; D013222:State Medicine; D015996:Survival Rate; D015912:Thrombolytic Therapy / Q000401:mortality / Q000706:statistics & numerical data / Q000639:trends
Estrategias de reperfusión; Fibrinolisis; Health policies; Infarto agudo de miocardio con elevación de segmento ST; Intervención coronaria percutánea primaria; Políticas de salud; Primary percutaneous coronary intervention; Redes de IAMCEST; Reperfusion strategies; ST-segment elevation acute myocardial infarction; STEMI network; Thrombolysis