- NEWS . 09 Sep 2019
Coronary revascularization rates associated with higher survival in non-ST-segment elevation acute coronary syndrome
In-hospital coronary revascularization rates (CRRs) may be a marker of higher system quality across hospital, country and regional levels in survivors of non-ST-segment elevation acute coronary syndrome (NSTE-ACS), according to a large multinational observational study.
Researchers analysed hospital CRR, by country and by world region, in 11,931 patients with NSTE-ACS who survived discharge and were enrolled in the EPICOR (long-tErm follow uP of antithrombotic management patterns In acute CORonary syndrome patients) and EPICOR Asia multinational, observational, prospective cohort studies. They found significant differences in patient baseline characteristics, medical therapies, CRR and 2-year post-discharge mortality rate (2YMR).
Mean CRR ranged from 53.9% in South East Asia (SE Asia) to 90.4% in South Korea-Singapore-Hong Kong, and from 12.3% in Romania to 92.4% in Slovenia (p<0.001).
2YMR varied significantly between hospital deciles of CRR (3.6% in tenth decile vs 9.2% in first decile; p<0.001), countries (lowest 1.5% in Slovenia, highest 19.4% in Malaysia; p<0.001) and regions (lowest 3.8% in South Korea-Singapore-Hong Kong, highest 11.7% in SE Asia; p<0.001). Poisson regression models, adjusted for 15 mortality predictors, showed a significant inverse association between CRR and 2YMR for hospitals (r=-0.90; p<0.001), countries (r=-0.65; p<0.001) and regions (r=-0.87; p=0.005).
Therefore, higher CRRs are strongly associated with higher post-discharge survival and may indicate higher system quality across hospital, country and regional levels.
Bueno H, et al. In-hospital coronary revascularization rates and post-discharge mortality risk in non-ST-segment elevation acute coronary syndrome. J Am Coll Cardiol 2019;74:1454-–1461.