Table 5

Multilevel multivariate analysis of factors associated with inhospital mortality in 58 hospitals treating acute coronary syndrome patients in six European countries

Multilevel model	Multivariable adjustment
Fixed-effect parameters	OR	95% CI	p Value
Baseline characteristics
Age vs <50 years
51–70	1.13	0.73 to 1.77	0.581
71–80	2.58	1.65 to 4.05	<0.001
81–101	4.18	2.63 to 6.63	<0.001
Gender F vs M	1.07	0.89 to 1.30	0.461
Diabetes	1.32	1.08 to 1.61	0.006
Hypertension
Yes	1.21	0.91 to 1.61	0.192
Not available	2.35	1.70 to 3.24	<0.001
Obesity (BMI >30 kg/m²)	0.74	0.58 to 0.95	0.019
Current smoking	0.69	0.51 to 0.92	0.013
History of CABG	0.78	0.53 to 1.16	0.221
History of CHD	0.91	0.75 to 1.12	0.395
Clinical presentation
STEMI vs NSTEMI	2.75	2.25 to 3.37	<0.001
Heart failure symptoms on admission
Acute pulmonary oedema	2.11	1.58 to 2.81	<0.001
Cardiogenic shock	12.35	8.84 to 17.26	<0.001
Troponin elevation
Yes	3.38	2.14 to 5.33	<0.001
Not available	10.7	6.3 to 18.18	<0.001
LVEF
35<LVEF≤55%	1.70	1.21 to 2.38	0.002
LVEF≤35%	7.28	5.25 to 10.10	<0.001
Not available	6.57	4.86 to 8.89	<0.001
Management strategy
PCI performed	0.35	0.28 to 0.44	<0.001
University hospital	1.28	0.93 to 1.76	0.122
Coronary care unit	1.04	0.47 to 2.28	0.921
Socioeconomic characteristics
GNP per capita in PPS	0.99	0.91 to 1.09	0.958
Gini coefficient (for a 0.001 increase)	0.99	0.96 to 1.08	0.682

Random effect parameters†	Variance	95% CI	p Value*

Hospital	0.17	0.08 to 0.35	<0.001
Country	0.29	0.08 to 1.08	<0.001

*Computed from log likelihood ratio test.
†Results can also be presented as an OR for death risk, comparing a hospital (or a country) at the 75th percentile of the hospital/country distribution to a hospital (or a country) at the 25th percentile of the hospital/country distribution: OR _{hospital (75th vs 25th percentile)}=1.74 (95% CI 1.46 to 2.22); OR _{country (75th vs 25th percentile)}=2.07 (95% CI 1.46 to 4.06);
BMI, body mass index; CABG, coronary arterial bypass graft surgery; CHD, coronary heart disease; GNP, gross national product; NSTEMI, non ST-elevation myocardial infarction; PCI, percutaneous coronary intervention; PPS, purchase power standardized; STEMI, ST-elevation myocardial infarction.