Abstract 16855: Comparison of Non-ST Segment Myocardial Infarction One-Year Outcomes at Academic vs Non-Academic Hospitals
Background: Prior studies have found academic hospitals provide more consistent evidence-based therapies and do more intervention in non-ST segment myocardial infarction (NSTEMI) patients than at nonacademic centers; whether these difference in care process translate into differences in short- or long-term outcome is unclear.
Methods: We compared 12,381 NSTEMI patients age >65 years treated at 107 academic hospitals with 30,954 NSTEMI patients treated at 341 non-academic hospitals from Feb 2003-Dec 2006 in CRUSADE Registry. Clinical data were then linked to Medicare longitudinal claims data. Short-term (30 days) and 1-year mortality among academic vs not centers was compared were after adjusting for clinical characteristics using a validated risk model (C-index 0.75).
Results: Patients treated at academic centers had slightly more cardiac risk factors. Academic centers used more early invasive strategy (49% vs 43%), in-hospital PCI (36% vs 30%), and CABG (10% vs 8%) than nonacademic centers, and were more likely to use evidence based discharge therapies (ASA 95% vs 93%; beta blocker 93% vs 91%; statin 81% v 74%; ACI or ARB 69% vs 67%). The 30-day mortality was 9.8% overall (8.9% academic vs 10.2% nonacademic); 1-year mortality was 24.6% (23.3% academic vs 25.1% nonacademic.). Academic centers had superior 30-day and 1-year risk adjusted outcomes than nonacademic centers (Table).
Conclusion: Patients with NSTEMI treated at academic centers received more aggressive evidence based treatments and interventions that were associated with improved short and long-term outcomes.
- © 2011 by American Heart Association, Inc.