Attainment of the ESC ACCA quality indicators for acute myocardial infarction, according to sex
| Quality indicator | Type of quality indicator | Patients eligible (n) | Total receiving care, n (%) n=691 290 | Women receiving care, n (%) n=238 489 | Men receiving care, n (%) n=452 801 | P values |
| 1. Centre organisation | ||||||
| 1.1. Centre organisation: part of network | Main | |||||
| 1.1a. Single emergency phone number to allow medical triage | 691 290 | 100 | 100 | |||
| 1.1b. Prehospital interpretation of the ECG | 365 927 | 247 940 (67.8) | 80 942 (67.1) | 166 998 (68.1) | <0.001 | |
| 1.1c. Prehospital activation of the catheter lab | 691 290 | 100 | 100 | |||
| 1.2. Routine assessment of times to reperfusion | Secondary | 691 290 | 100 | 100 | ||
| 1.3. Participate in regular registry | Secondary | 691 290 | 100 | 100 | ||
| 2. Reperfusion/invasive strategy | ||||||
| 2.1. Reperfusion within 12 hours of presentation (STEMI) | Main | 177 418 | 153 394 (86.5) | 40 577 (84.9) | 112 817 (87.0) | <0.001 |
| 2.2. Timely reperfusion (STEMI) | Main | 157 352 | 123 282 (78.3) | 32 007 (76.8) | 91 275 (78.9) | <0.001 |
| 2.2a. Fibrinolysis received within 30 min (PPCI centres and STEMI only) | 8243 | 3310 (40.2) | 862 (37.5) | 2448 (41.1) | 0.002 | |
| 2.2b. Primary PCI received within 60 min (PPCI centres and STEMI only) | 101 426 | 76 095 (75.0) | 19 349 (73.3) | 56 746 (75.6) | <0.001 | |
| 2.2c. Primary PCI received within 120 min (non-PPCI and STEMI only) | 47 201 | 43 622 (92.4) | 11 739 (91.2) | 31 883 (92.9) | <0.001 | |
| 2.2d. Door-in to door-out time within 30 min (non-PPCI centres and STEMI only) | 2173 | 631 (29.0) | 131 (26.3) | 500 (29.9) | 0.118 | |
| 2.3. Coronary angiography received within 72 hours (NSTEMI only) | Main | 419 048 | 134 290 (32.0) | 38 044 (24.2) | 96 246 (36.7) | <0.001 |
| 2.4. Time from diagnosis to wire passage (STEMI), min (median, IQR min) | Secondary | 80 734 | 44 (30–68) | 46 (31–71) | 44 (30–67) | <0.001 |
| 3. In-hospital risk assessment | ||||||
| 3.1. GRACE risk score recorded in notes | Main | NA | NA | NA | NA | NA |
| 3.2. CRUSADE risk score recorded in notes | Main | NA | NA | NA | NA | NA |
| 3.3. Left ventricular function recorded in notes | Main | 691 290 | 336 228 (48.6) | 111 991 (47.0) | 224 237 (49.5) | <0.001 |
| 4. Antithrombotics during hospital stay | ||||||
| 4.1. Adequate P2Y12 inhibition on hospital discharge | Main | 410 325 | 343 117 (83.6) | 113 457 (81.3) | 229 660 (84.8) | <0.001 |
| 4.2. Fondaparinux received (NSTEMI only) | Main | 220 635 | 53 951 (24.4) | 19 856 (24.2) | 34 059 (24.6) | 0.028 |
| 4.3. Dual antiplatelet therapy received on hospital discharge | Secondary | 387 565 | 300 767 (77.6) | 98 519 (75.4) | 202 248 (78.7) | <0.001 |
| 5. Secondary prevention | ||||||
| 5.1. High-intensity statins on hospital discharge | Main | 575 551 | 511 350 (88.8) | 167 788 (87.2) | 343 562 (89.6) | <0.001 |
| 5.2. ACEi/ARB on discharge for those with heart failure or LVSD | Secondary | 167 221 | 141 152 (84.4) | 53 597 (82.5) | 87 555 (85.6) | <0.001 |
| 5.3. Beta-blocker on hospital discharge for those with heart failure or LVSD | Secondary | 196 280 | 128 886 (65.7) | 48 038 (62.6) | 80 848 (67.6) | <0.001 |
| 6. Patient satisfaction | ||||||
| 6.1. Not applicable | Main | NA | NA | NA | NA | NA |
| 7. Composite QI | ||||||
| 7.1. Composite QI (opportunity based) reported as percentage, median (IQR) | Main | 691 290 | 75.0 (50.0–85.7) | 71.4 (50.0–83.3) | 80.0 (57.1–100.0) | <0.001 |
| 7.2. Composite QI (all-or-none, overall score) | Secondary | 691 290 | 503 636 (72.9) | 165 733 (69.5) | 337 903 (74.6) | <0.001 |
| 7.2a. Composite QI (all-or-none, three measures) (%) patients with no heart failure or left ventricular ejection fraction ≤0.40 | Secondary | 467 825 | 374 122 (80.0) | 116 760 (78.3) | 257 362 (80.8) | <0.001 |
| 7.2b. Composite QI (all-or-none, five measures) (%) patients with heart failure or left ventricular ejection fraction ≤0.40 | Secondary | 223 465 | 129 514 (57.8) | 48 973 (54.8) | 80 541 (60.1) | <0.001 |
| 7.3. Mortality rate adjusted for GRACE risk score (median, IQR)* | 305 549 | 3.1% (1.0–9.2) | 5.2% (1.8–13.1) | 2.3% (0.8–7.1) | <0.001 | |
| 7.3. Mortality rate adjusted for GRACE risk score (mean, SD)* | 305 549 | 7.6% (11.0) | 9.9% (12.2) | 6.3% (10.1) | <0.001 | |
Comparisons were made using Χ2 for categorical data, t-test for normally distributed and Mann-Whitney U test for non-normally distributed data.
*Modelling based on complete cases only.
ACCA, Acute Cardiovascular Care Association; ACEi/ARB, ACE inhibitor/angiotensin II receptor blocker; CRUSADE, Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines; ESC, European Society of Cardiology; GRACE, Global Registry of Acute Coronary Events; LVSD, left ventricular systolic dysfunction; NA, not applicable; NSTEMI, non-STEMI; PCI, percutaneous coronary intervention; PPCI, primary PCI; QI, quality indicator; STEMI, ST-elevation myocardial infarction.