title: Effect of part-time cardiac catheterization facilities in patients with acute myocardial infarction.
abstract: BACKGROUND
  Although the easy availability of invasive cardiac care facilities is associated with an increase in their use, their influence on outcomes is not clear. We sought to investigate whether a newly available cardiac catheterization laboratory (CCL) performing percutaneous coronary intervention (PCI) on a part-time (PT) basis might improve outcomes in patients with acute myocardial infarction (AMI).
  
  
  METHODS
  This was an observational cohort study that included all consecutive patients with AMI admitted to a secondary-level hospital in Spain before and after the PT-CCL opened in January 2006: during 1998-2005 and 2006-2014, respectively. All-cause in-hospital and long-term mortality were the co-primary endpoints. In-hospital complications and length of stay were secondary endpoints. For the analyses, patients were stratified according to propensity-score (PS) quintiles.
  
  
  RESULTS
  A total of 5339 patients were recruited, and 50.3% were managed after the opening of the PT-CCL. The PT-CCL was associated with greater use of PCI (81.2 vs. 32.5%, p<0.001) and guidelines-recommended medication (all p<0.001), lower risk of recurrent angina (PS-adjusted RR=0.160, 95% CI 0.115-0.222) and shorter length of hospital stay (PS-adjusted RR for length of stay <8days=0.357, 95% CI 0.301-0.422). In patients with NSTEMI, PT-CCL was associated with improved long-term survival (PS-adjusted HR=0.764, 95% CI 0.602-0.970).
  
  
  CONCLUSIONS
  In patients with AMI, a new PT-CCL was associated with greater use of PCI and guideline-recommended medication, lower risk of recurrent angina and shorter length of hospital stay. In a subset of patients with NSTEMI, PT-CCL was associated with improved long-term survival.
authors.affiliation: Cardiology Department and Acute Coronary Care Unit, Universidad Católica de Murcia-UCAM, Hospital Universitario Santa Lucía de Cartagena, Spain. Electronic address: lconsuegra@ucam.edu.
authors.forename: Luciano
authors.initials: L
authors.lastname: Consuegra-Sánchez
authors.affiliation: Cardiology Department and Acute Coronary Care Unit, Universidad Católica de Murcia-UCAM, Hospital Universitario Santa Lucía de Cartagena, Spain.
authors.forename: Leticia
authors.initials: L
authors.lastname: Jaulent-Huertas
authors.affiliation: Acute Coronary Care Unit, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Vicente-Gilabert
authors.affiliation: Cardiology Department and Acute Coronary Care Unit, Universidad Católica de Murcia-UCAM, Hospital Universitario Santa Lucía de Cartagena, Spain.
authors.forename: Ángela
authors.initials: Á
authors.lastname: Díaz-Pastor
authors.affiliation: Cardiology Department and Acute Coronary Care Unit, Universidad Católica de Murcia-UCAM, Hospital Universitario Santa Lucía de Cartagena, Spain.
authors.forename: Germán
authors.initials: G
authors.lastname: Escudero-García
authors.affiliation: Cardiology Department and Acute Coronary Care Unit, Universidad Católica de Murcia-UCAM, Hospital Universitario Santa Lucía de Cartagena, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Alonso-Fernández
authors.affiliation: Cardiology Department and Acute Coronary Care Unit, Universidad Católica de Murcia-UCAM, Hospital Universitario Santa Lucía de Cartagena, Spain.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Gil-Sánchez
authors.affiliation: Cardiology Department and Acute Coronary Care Unit, Universidad Católica de Murcia-UCAM, Hospital Universitario Santa Lucía de Cartagena, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Martínez-Hernández
authors.affiliation: Cardiology Department, University Clinic Hospital, INCLIVA, Department of Medicine, University of Valencia, CIBER-CV, Valencia, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchis-Forés
authors.affiliation: Acute Coronary Care Unit, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Galcerá-Tomás
authors.affiliation: Cardiology Department and Acute Coronary Care Unit, Universidad Católica de Murcia-UCAM, Hospital Universitario Santa Lucía de Cartagena, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Melgarejo-Moreno
mesh_terms: D000787:Angina Pectoris / Q000517:prevention & control*; D006328:Cardiac Catheterization / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006739:Hospital Administration / Q000379:methods*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007902:Length of Stay / Q000639:trends*; D000069451:Long Term Adverse Effects / Q000453:epidemiology / Q000209:etiology; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy; D009936:Organizational Innovation; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D055502:Secondary Prevention / Q000706:statistics & numerical data; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis
keywords: Catheterization; Health resources and outcomes; Myocardial infarction