Table 5

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

Multilevel modelMultivariable adjustment
Fixed-effect parametersOR95% CIp Value
Baseline characteristics
Age vs <50 years
 51–701.130.73 to 1.770.581
 71–802.581.65 to 4.05<0.001
 81–1014.182.63 to 6.63<0.001
Gender F vs M1.070.89 to 1.300.461
Diabetes1.321.08 to 1.610.006
 Yes1.210.91 to 1.610.192
 Not available2.351.70 to 3.24<0.001
Obesity (BMI >30 kg/m²)0.740.58 to 0.950.019
Current smoking0.690.51 to 0.920.013
History of CABG0.780.53 to 1.160.221
History of CHD0.910.75 to 1.120.395
Clinical presentation
 STEMI vs NSTEMI2.752.25 to 3.37<0.001
Heart failure symptoms on admission
 Acute pulmonary oedema2.111.58 to 2.81<0.001
 Cardiogenic shock12.358.84 to 17.26<0.001
Troponin elevation
 Yes3.382.14 to 5.33<0.001
 Not available10.76.3 to 18.18<0.001
 35<LVEF≤55%1.701.21 to 2.380.002
 LVEF≤35%7.285.25 to 10.10<0.001
 Not available6.574.86 to 8.89<0.001
Management strategy
 PCI performed0.350.28 to 0.44<0.001
 University hospital1.280.93 to 1.760.122
 Coronary care unit1.040.47 to 2.280.921
Socioeconomic characteristics
 GNP per capita in PPS0.990.91 to 1.090.958
 Gini coefficient (for a 0.001 increase)0.990.96 to 1.080.682
Random effect parameters†Variance95% CI p Value*
 Hospital0.170.08 to 0.35<0.001
 Country0.290.08 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.