Comparing In-Hospital Outcomes for Acute Myocardial Infarction Patients in High-Volume Hospitals Performing Primary Percutaneous Coronary Intervention vs. Regional General Hospitals

• Published in: Circulation Journal Vol. 87; no. 10; pp. CJ-23-0188 - 1355
• Main Authors: Sasaki, Koto, Koeda, Yorihiko, Yoshizawa, Reisuke, Ishikawa, Yuh, Ishida, Masaru, Itoh, Tomonori, Morino, Yoshihiro, Saitoh, Hidenori, Onodera, Hiroyuki, Nozaki, Tetsuji, Maegawa, Yuko, Nishiyama, Osamu, Ozawa, Mahito, Osaki, Takuya, Nakamura, Akihiro
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 25-09-2023
• Subjects: Acute myocardial infarction; High-volume hospitals; Hospital Mortality; Hospitals, General; Hospitals, High-Volume; Humans; Myocardial Infarction - surgery; Percutaneous Coronary Intervention - methods; Primary percutaneous coronary intervention; Retrospective Studies; Rural-urban disparity; ST Elevation Myocardial Infarction - surgery; Treatment Outcome; Primary percutaneous coronary intervention; High-volume hospitals; Rural-urban disparity; Acute myocardial infarction
• ISSN: 1346-9843; 1347-4820; 1347-4820
• DOI: 10.1253/circj.CJ-23-0188

Background: It has been reported that patients with acute myocardial infarction (AMI) transferred to low-volume primary percutaneous coronary intervention (PCI) hospitals (<115/year) in low population density areas experience higher in-hospital mortality rates. This study compared in-hospital outcomes of patients admitted to high-volume primary PCI hospitals (≥115/year) with those for other regional general hospitals.Methods and Results: Retrospective analysis was conducted on data obtained from 2,453 patients with AMI admitted to hospitals in Iwate Prefecture (2014–2018). Multivariate analysis revealed that the in-hospital mortality rate of AMI among patients in regional general hospitals was significantly higher than among patients in high-volume hospitals. However, no significant difference in mortality rate was observed among patients with ST-elevation myocardial infarction (STEMI) undergoing primary PCI. Although no significant difference was found in the in-hospital mortality rate of patients with Killip class I STEMI, significantly lower in-hospital mortality rates were observed in patients admitted in high-volume hospitals for Killip classes II, III, and IV.Conclusions: Although in-hospital outcomes for patients with STEMI undergoing primary PCI were similar, patients with heart failure or cardiogenic shock exhibited better in-hospital outcomes in high-volume primary PCI hospitals than those in regional general hospitals.