Details

Autor(en) / Beteiligte

• Mathew, Anoop
• Jabir, A
• Zheng, Yinggan
• Westerhout, Cindy
• Viswanathan, Sunitha
• Sebastian, Placid
• Kumar, Prasanna
• Bainey, Kevin R
• Welsh, Robert C

Titel

Abstract 14064: Procedural Volume and Outcomes After Primary Angioplasty for ST-Segment Elevation Myocardial Infarction in Kerala, India: Results of the Cardiology Society of India-Kerala Primary Angioplasty Registry

Ist Teil von

• Circulation (New York, N.Y.), 2019-11, Vol.140 (Suppl_1 Suppl 1), p.A14064-A14064

Ort / Verlag

by the American College of Cardiology Foundation and the American Heart Association, Inc

Erscheinungsjahr

2019

Link zum Volltext

Quelle

Free E-Journal (出版社公開部分のみ）

Beschreibungen/Notizen

• IntroductionThere is limited data to inform policy mandating primary PCI (PPCI) volume benchmarks for cardiac catheterization labs in low- and middle-income countries.HypothesisHigher volume PPCI hospitals may have better outcomes compared to lower volume hospitals.MethodsAll STEMI patients, >18 years with chest pain of <12 hours, undergoing PPCI were included in a state-wide registry. From June 2013 till March 2016, 5560 consecutive PPCI cases were recruited and followed up for 1 year. Hospitals were categorized based on the annual PPCI volumes into low, medium and high-volume (<100, 100-199 and ≥ 200, respectively) as well as into private or public.ResultsOf the 42 recruiting hospitals, there were 24 (57.2%) low-, 8 (19%) intermediate- and 10 (23.8%) high-volume hospitals. There were 4 public hospitals all of which were high-volume. The median TIMI risk score was 3 (IQR, 2-5). Cardiac arrest prior to admission occurred in 4.2%, 2.1% and 2.9% of cases at low, medium and high-volume hospitals (p=0.02). Total ischemic time was longer at high (median [IQR] 4.16 [2.8-6.3] hours) compared to low (3.5 [2.4-5.5] hours) and medium-volume hospitals (3.8 [2.58-6.05] hours) (p=0.01). Radial access was used in 71.3% in medium compared to 61.5% in low and 63.2% in high-volume hospitals (p=0.01). High-volume hospitals had lower thrombus aspiration use (34.8%) compared to low (45.2%) and medium (37.5%) (p=0.01). The un-adjusted 1-year mortality rate was 6.5% in low, 3.4% in medium and 8.6% in high-volume hospitals, which was not attenuated by multivariate adjustment (low vs mediumHR [95% CI] 1.86 [1.21-2.87], high vs mediumHR [95% CI] 2.56 [1.88-3.49]).ConclusionsA parabolic relationship between hospital-level annual PPCI volumes and STEMI outcomes may be present in Kerala, India, with medium-volume hospitals having better outcomes compared to low and high-volume hospitals, although the influence of private versus public hospitals deserves investigation.