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Trends in hospital treatments, including revascularisation, following acute myocardial infarction, 2003–2010: a multilevel and relative survival analysis for the National Institute for Cardiovascular Outcomes Research (NICOR)
  1. C P Gale1,2,
  2. V Allan1,
  3. B A Cattle1,
  4. A S Hall3,
  5. R M West4,
  6. A Timmis5,
  7. H H Gray6,
  8. J Deanfield7,
  9. K A A Fox8,
  10. R Feltbower1
  1. 1Division of Epidemiology and Biostatistics, University of Leeds, Leeds, UK
  2. 2Department of Cardiology, York Teaching Hospital NHS Foundation Trust, York, UK
  3. 3Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  4. 4Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
  5. 5Department of Cardiology, London Chest Hospital, London, UK
  6. 6Department of Cardiology, University Hospital of Southampton, Southampton, UK
  7. 7National Institute for Cardiovascular Outcomes, University College London, London, UK
  8. 8Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Chris P Gale, Division of Biostatistics, School of Medicine, Level 8, Worsley building, University of Leeds, Clarendon Way, West Yorkshire, Leeds LS2 9JT, UK; c.p.gale{at}leeds.ac.uk

Abstract

Objective To investigate temporal changes in survival after acute myocardial infarction (AMI) by early invasive strategy.

Methods Accelerated failure time and 6-month relative survival analyses stratified by thrombolysis or primary percutaneous coronary intervention (PPCI) for ST elevation myocardial infarction (STEMI) and coronary angiography for non-STEMI (NSTEMI) encompassing 583 466 patients across 247 hospitals in England and Wales over hospital admission periods 2003–2004, 2005–2006, 2007–2008 and 2009–2010.

Results Survival improved significantly for STEMI patients who received reperfusion therapy (time ratio (TR) 1.47, 95% CI 1.22 to 2.78) and was stable for those who did not (TR 1.02, 95% CI 0.85 to 1.22). While there were significant improvements in survival for NSTEMI patients who underwent coronary angiography (TR 1.39, 95% CI 1.18 to 1.62), there was a significant decline for those who did not (TR 0.70, 95% CI 0.65 to 0.75). Patients without reperfusion therapy or coronary angiography had a greater number of comorbidities, but the use of secondary prevention medications was comparable with patients who received reperfusion therapy or coronary angiography. There was a significant hospital-level survival effect, with higher crude 6-month mortality in hospitals in the lowest coronary angiography and PPCI quartiles (angiography Q1: 16.4% vs Q4: 12.8%; PPCI Q1: 15.8% vs Q4: 12.4%).

Conclusions Survival rates after AMI have improved. Whereas survival estimates for STEMI patients who did not receive reperfusion therapy were stable, they worsened for NSTEMI patients not receiving coronary angiography.

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