Abstract 4330: Hospitals With Percutaneous Coronary Intervention Capability Deliver Superior Quality of Care in Myocardial Infarction
BACKGROUND ACC/AHA guidelines for acute myocardial infarction (AMI) related to process of care aim to decrease morbidity and mortality and provide a standard of care for patients with AMI. Current data have demonstrated that hospital centers with higher volume of AMI patients are superior in achieving these guidelines. However, there are limited data comparing adherence between centers providing fibrinolytic therapy alone and those that provide percutaneous coronary intervention (PCI).
METHODS Specific ACC/AHA performance measures for all hospitals treating AMI patients were analyzed from the US Department of Health and Human Services Hospital Compare website. These included aspirin on arrival and discharge, beta-blockers on arrival and discharge, angiotensin-converting enzyme (ACE) or angiotensin-receptor blocking (ARB) agents for left ventricular dysfunction (LVd) as well as smoking cessation advice and counseling. Risk-adjusted mortality rates were also evaluated for all hospitals listed. Reporting hospitals were divided into PCI capable centers and fibrinolytic only centers. A Chi-square analysis was used to compare results between hospital centers.
RESULTS Adherence with all reported process of care measurements were significantly higher (p<0.0001 for all measurements) in hospitals reporting PCI capability in comparison to hospitals that only use fibrinolytics in AMI patients. Additionally, mortality was lower in PCI capable centers versus fibrinolytic centers (p<0.0001).
CONCLUSION Hospitals using fibrinolytic therapy alone for AMI patients had significantly lower rates of adherence to ACC/AHA performance measures as well as higher overall mortality.