Cargando…

Revascularization Treatment of Emergency Patients with Acute ST-Segment Elevation Myocardial Infarction in Switzerland: Results from a Nationwide, Cross-Sectional Study in Switzerland for 2010-2011

BACKGROUND: Cardiovascular diseases are the leading cause of death worldwide and in Switzerland. When applied, treatment guidelines for patients with acute ST-segment elevation myocardial infarction (STEMI) improve the clinical outcome and should eliminate treatment differences by sex and age for pa...

Descripción completa

Detalles Bibliográficos
Autores principales: Berlin, Claudia, Jüni, Peter, Endrich, Olga, Zwahlen, Marcel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4831744/
https://www.ncbi.nlm.nih.gov/pubmed/27078262
http://dx.doi.org/10.1371/journal.pone.0153326
_version_ 1782427123415252992
author Berlin, Claudia
Jüni, Peter
Endrich, Olga
Zwahlen, Marcel
author_facet Berlin, Claudia
Jüni, Peter
Endrich, Olga
Zwahlen, Marcel
author_sort Berlin, Claudia
collection PubMed
description BACKGROUND: Cardiovascular diseases are the leading cause of death worldwide and in Switzerland. When applied, treatment guidelines for patients with acute ST-segment elevation myocardial infarction (STEMI) improve the clinical outcome and should eliminate treatment differences by sex and age for patients whose clinical situations are identical. In Switzerland, the rate at which STEMI patients receive revascularization may vary by patient and hospital characteristics. AIMS: To examine all hospitalizations in Switzerland from 2010–2011 to determine if patient or hospital characteristics affected the rate of revascularization (receiving either a percutaneous coronary intervention or a coronary artery bypass grafting) in acute STEMI patients. DATA AND METHODS: We used national data sets on hospital stays, and on hospital infrastructure and operating characteristics, for the years 2010 and 2011, to identify all emergency patients admitted with the main diagnosis of acute STEMI. We then calculated the proportion of patients who were treated with revascularization. We used multivariable multilevel Poisson regression to determine if receipt of revascularization varied by patient and hospital characteristics. RESULTS: Of the 9,696 cases we identified, 71.6% received revascularization. Patients were less likely to receive revascularization if they were female, and 80 years or older. In the multivariable multilevel Poisson regression analysis, there was a trend for small-volume hospitals performing fewer revascularizations but this was not statistically significant while being female (Relative Proportion = 0.91, 95% CI: 0.86 to 0.97) and being older than 80 years was still associated with less frequent revascularization. CONCLUSION: Female and older patients were less likely to receive revascularization. Further research needs to clarify whether this reflects differential application of treatment guidelines or limitations in this kind of routine data.
format Online
Article
Text
id pubmed-4831744
institution National Center for Biotechnology Information
language English
publishDate 2016
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-48317442016-04-22 Revascularization Treatment of Emergency Patients with Acute ST-Segment Elevation Myocardial Infarction in Switzerland: Results from a Nationwide, Cross-Sectional Study in Switzerland for 2010-2011 Berlin, Claudia Jüni, Peter Endrich, Olga Zwahlen, Marcel PLoS One Research Article BACKGROUND: Cardiovascular diseases are the leading cause of death worldwide and in Switzerland. When applied, treatment guidelines for patients with acute ST-segment elevation myocardial infarction (STEMI) improve the clinical outcome and should eliminate treatment differences by sex and age for patients whose clinical situations are identical. In Switzerland, the rate at which STEMI patients receive revascularization may vary by patient and hospital characteristics. AIMS: To examine all hospitalizations in Switzerland from 2010–2011 to determine if patient or hospital characteristics affected the rate of revascularization (receiving either a percutaneous coronary intervention or a coronary artery bypass grafting) in acute STEMI patients. DATA AND METHODS: We used national data sets on hospital stays, and on hospital infrastructure and operating characteristics, for the years 2010 and 2011, to identify all emergency patients admitted with the main diagnosis of acute STEMI. We then calculated the proportion of patients who were treated with revascularization. We used multivariable multilevel Poisson regression to determine if receipt of revascularization varied by patient and hospital characteristics. RESULTS: Of the 9,696 cases we identified, 71.6% received revascularization. Patients were less likely to receive revascularization if they were female, and 80 years or older. In the multivariable multilevel Poisson regression analysis, there was a trend for small-volume hospitals performing fewer revascularizations but this was not statistically significant while being female (Relative Proportion = 0.91, 95% CI: 0.86 to 0.97) and being older than 80 years was still associated with less frequent revascularization. CONCLUSION: Female and older patients were less likely to receive revascularization. Further research needs to clarify whether this reflects differential application of treatment guidelines or limitations in this kind of routine data. Public Library of Science 2016-04-14 /pmc/articles/PMC4831744/ /pubmed/27078262 http://dx.doi.org/10.1371/journal.pone.0153326 Text en © 2016 Berlin et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Berlin, Claudia
Jüni, Peter
Endrich, Olga
Zwahlen, Marcel
Revascularization Treatment of Emergency Patients with Acute ST-Segment Elevation Myocardial Infarction in Switzerland: Results from a Nationwide, Cross-Sectional Study in Switzerland for 2010-2011
title Revascularization Treatment of Emergency Patients with Acute ST-Segment Elevation Myocardial Infarction in Switzerland: Results from a Nationwide, Cross-Sectional Study in Switzerland for 2010-2011
title_full Revascularization Treatment of Emergency Patients with Acute ST-Segment Elevation Myocardial Infarction in Switzerland: Results from a Nationwide, Cross-Sectional Study in Switzerland for 2010-2011
title_fullStr Revascularization Treatment of Emergency Patients with Acute ST-Segment Elevation Myocardial Infarction in Switzerland: Results from a Nationwide, Cross-Sectional Study in Switzerland for 2010-2011
title_full_unstemmed Revascularization Treatment of Emergency Patients with Acute ST-Segment Elevation Myocardial Infarction in Switzerland: Results from a Nationwide, Cross-Sectional Study in Switzerland for 2010-2011
title_short Revascularization Treatment of Emergency Patients with Acute ST-Segment Elevation Myocardial Infarction in Switzerland: Results from a Nationwide, Cross-Sectional Study in Switzerland for 2010-2011
title_sort revascularization treatment of emergency patients with acute st-segment elevation myocardial infarction in switzerland: results from a nationwide, cross-sectional study in switzerland for 2010-2011
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4831744/
https://www.ncbi.nlm.nih.gov/pubmed/27078262
http://dx.doi.org/10.1371/journal.pone.0153326
work_keys_str_mv AT berlinclaudia revascularizationtreatmentofemergencypatientswithacutestsegmentelevationmyocardialinfarctioninswitzerlandresultsfromanationwidecrosssectionalstudyinswitzerlandfor20102011
AT junipeter revascularizationtreatmentofemergencypatientswithacutestsegmentelevationmyocardialinfarctioninswitzerlandresultsfromanationwidecrosssectionalstudyinswitzerlandfor20102011
AT endricholga revascularizationtreatmentofemergencypatientswithacutestsegmentelevationmyocardialinfarctioninswitzerlandresultsfromanationwidecrosssectionalstudyinswitzerlandfor20102011
AT zwahlenmarcel revascularizationtreatmentofemergencypatientswithacutestsegmentelevationmyocardialinfarctioninswitzerlandresultsfromanationwidecrosssectionalstudyinswitzerlandfor20102011