Regional variations in hospital management and post-discharge mortality in patients with non-ST-segment elevation acute coronary syndrome

Bueno, Héctor; Rosselló, Xavier; Pocock, Stuart J.; Werf, Frans Van de; Chin, Chee Tang; Danchin, Nicolás; Lee, Stephen W-L; Medina, Jesús; Vega, Ana María Fernández; Huo, Yong

doi:10.1007/s00392-018-1254-y

Cited by 39 publications

(41 citation statements)

References 23 publications

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“…Risk stratification in patients presenting with suspected acute myocardial infarction (AMI) is of major clinical relevance to identify individuals at risk of death and guide further diagnostics and or therapeutic pathways [1]. The wide range of potential differential diagnoses in these patients, including harmless conditions, but also acute life-threatening diseases such as pulmonary embolism and myocardial infarction, challenges risk prediction [2, 3].…”

Section: Introductionmentioning

confidence: 99%

Predictive value of soluble urokinase-type plasminogen activator receptor for mortality in patients with suspected myocardial infarction

et al. 2019

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BackgroundEarly risk stratification of patients with suspected acute myocardial infarction (AMI) constitutes an unmet need in current daily clinical practice. We aimed to evaluate the predictive value of soluble urokinase-type plasminogen activator receptor (suPAR) levels for 1-year mortality in patients with suspected AMI.Methods and resultssuPAR levels were determined in 1314 patients presenting to the emergency department with suspected AMI. Patients were followed up for 12 months to assess all-cause mortality. Of 1314 patients included, 308 were diagnosed with AMI. Median suPAR levels did not differ between subjects with AMI compared to non-AMI (3.5 ng/ml vs. 3.2 ng/ml, p = 0.066). suPAR levels reliably predicted all-cause mortality after 1 year. Hazard ratio for 1-year mortality was 12.6 (p < 0.001) in the quartile with the highest suPAR levels compared to the first quartile. The prognostic value for 6-month mortality was comparable to an established risk prediction model, the Global Registry of Acute Coronary Events (GRACE) score, with an AUC of 0.79 (95% CI 0.72–0.86) for the GRACE score and 0.77 (95% CI 0.69–0.84) for suPAR. Addition of suPAR improved the GRACE score, as shown by integrated discrimination improvement statistics of 0.036 (p = 0.03) suggesting a further discrimination of events from non-events by the addition of suPAR.ConclusionssuPAR levels reliably predicted mortality in patients with suspected AMI.Study registrationhttp://www.clinicaltrials.gov (NCT02355457).Electronic supplementary materialThe online version of this article (10.1007/s00392-019-01475-1) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Predictive value of soluble urokinase-type plasminogen activator receptor for mortality in patients with suspected myocardial infarction

et al. 2019

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“…Similarly, recording the time to reperfusion was not associated with poor prognosis, despite there being plenty of evidence showing that the shorter the time, the better the survival. 25 Two main differences between our cohort and previous reports assessing QIs 12,13 are evident: the very low proportion of patients with timely reperfusion – attributable to the international nature of our registry, including countries where STEMI networks may not be as well developed as in France or the UK 8,9 – and the high degree of compliance with cQIs. Most QIs were associated with reduced mortality internationally.…”

Section: Discussionmentioning

confidence: 82%

“…aspirin, statins) is worthwhile, as they leave little room for improvement, whilst there are still vast differences in management and outcomes across countries. 8,9 The need for additional QIs should also be considered, particularly those affecting few patients (i.e. those related to LVSD and/or heart failure).…”

Section: Discussionmentioning

confidence: 99%

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Assessment of quality indicators for acute myocardial infarction management in 28 countries and use of composite quality indicators for benchmarking

Rosselló

Medina

Pocock

et al. 2020

European Heart Journal. Acute Cardiovascular Care

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Background: The European Society of Cardiology established a set of quality indicators for the management of acute myocardial infarction. Our aim was to evaluate their degree of attainment, prognostic value and potential use for centre benchmarking in a large international cohort. Methods: Quality indicators were extracted from the long-tErm follow-uP of antithrombotic management patterns In acute CORonary syndrome patients (EPICOR) (555 hospitals, 20 countries in Europe and Latin America, 2010–2011) and EPICOR Asia (218 hospitals, eight countries, 2011–2012) registries, including non-ST-segment elevation acute myocardial infarction ( n=6558) and ST-segment elevation acute myocardial infarction ( n=11,559) hospital survivors. The association between implementation rates for each quality indicator and two-year adjusted mortality was evaluated using adjusted Cox models. Composite quality indicators were categorized for benchmarking assessment at different levels. Results: The degree of attainment of the 17 evaluated quality indicators ranged from 13% to 100%. Attainment of most individual quality indicators was associated with two-year survival. A higher compliance with composite quality indicators was associated with lower mortality at centre-, country- and region-level. Moreover, the higher the risk for two-year mortality, the lower the compliance with composite quality indicators. Conclusions: When EPICOR and EPICOR Asia were conducted, the European Society of Cardiology quality indicators would have been attained to a limited extent, suggesting wide room for improvement in the management of acute myocardial infarction patients. After adjustment for confounding, most quality indicators were associated with reduced two-year mortality and their prognostic value should receive further attention. The two composite quality indicators can be used as a tool for benchmarking either at centre-, country- or world region-level.

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“…in patient features, hospital care or clinical outcomes after discharge among MI patients. 38,39 Finally, this was not a population-based study. The participating institutions are regional centres capable of advanced medical management.…”

Section: Discussionmentioning

confidence: 95%

Guideline adherence and long-term clinical outcomes in patients with acute myocardial infarction: a Japanese Registry of Acute Myocardial Infarction Diagnosed by Universal Definition (J-MINUET) substudy

Wada

Ogita

Suwa

et al. 2020

European Heart Journal. Acute Cardiovascular Care

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Background: The association between guideline adherence and long-term outcomes in patients with acute myocardial infarction in real-world clinical practice remains unclear. Methods: We investigated 3283 consecutive patients with acute myocardial infarction who were selected from a prospective, nation-wide, multicentre registry (J-MINUET) database covering 28 institutions in Japan between July 2012 and March 2014. Among the 2757 eligible patients, we evaluated the use of seven guideline-recommended therapies, including urgent revascularisation, door-to-balloon time of 90 minutes or less, and five discharge medications (P2Y12 inhibitors on aspirin, beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, statins, lipid-lowering drugs). The primary endpoint was a composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, cardiac failure and urgent revascularisation for unstable angina up to 3 years. Results: The overall median composite guideline adherence was 85.7%. Patients were divided into the following three groups: complete (100%) adherence group ( n=862); moderate adherence (75% to <100%) group ( n=911); and low adherence (0–75%) group ( n=984). The rate of adverse cardiovascular events was significantly lower in the complete adherence group than in the low and moderate adherence groups (log rank P<0.0001). Multivariate Cox regression analysis showed complete guideline adherence was also significantly associated with lower adverse cardiovascular events compared with low guideline adherence (hazard ratio 0.66; 95% confidence interval 0.52–0.85; P=0.001). Conclusion: The use of guideline-based therapies for patients with acute myocardial infarction in contemporary clinical practice was associated with significant decreases in adverse long-term clinical outcomes. Trial registration: UMIN Unique trial Number: UMIN000010037

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Regional variations in hospital management and post-discharge mortality in patients with non-ST-segment elevation acute coronary syndrome

Abstract: Wide regional variations in patient features, hospital care, coronary revascularization and post-discharge mortality are present among patients hospitalized for NSTE-ACS. Focused regional interventions to improve the quality of care for NSTE-ACS patients are still needed.

Cited by 39 publications

References 23 publications

Predictive value of soluble urokinase-type plasminogen activator receptor for mortality in patients with suspected myocardial infarction

Predictive value of soluble urokinase-type plasminogen activator receptor for mortality in patients with suspected myocardial infarction

Assessment of quality indicators for acute myocardial infarction management in 28 countries and use of composite quality indicators for benchmarking

Guideline adherence and long-term clinical outcomes in patients with acute myocardial infarction: a Japanese Registry of Acute Myocardial Infarction Diagnosed by Universal Definition (J-MINUET) substudy

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