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Jose Labarere, MD; Loic Belle, MD; Magali Fourny, MSc; Nathalie Genès, MD; Jean-Marc Lablanche, MD; Didier Blanchard, MD; Jean-Pierre Cambou, MD; Nicolas Danchin, MD; for the Unité de Soins Intensifs Coronaires 2000 Investigators

Arch Intern Med. 2007;167(9):913-920.

Background  Despite evidence on the efficacy and safety of percutaneous coronary intervention (PCI) for patients with acute myocardial infarction, it is unclear whether patients admitted to hospitals with on-site PCI facilities (hereinafter, PCI hospitals) have improved outcomes in routine practice.

Methods  We compared processes of care, hospital outcomes, and 1-year mortality rate for 1176 consecutive patients admitted to 126 PCI hospitals and 738 patients admitted to 190 non-PCI hospitals in France from November 1 to November 30, 2000.

Results  Patients admitted to PCI hospitals were more likely to receive evidence-based acute (within 48 hours of admission) and discharge medications and to undergo PCI within 48 hours of admission than those admitted to non-PCI hospitals (54% vs 6.2%; P<.001). Despite comparable rates of in-hospital stroke (0.9% vs 1.1%; P = .75) and reinfarction (1.7% vs 2.5%; P = .25), patients admitted to PCI vs non-PCI hospitals had lower in-hospital (7.5% vs 12%; P = .001) and 1-year (13% vs 20%; P<.001) mortality rates. Admission to PCI hospitals was associated with decreased hazard ratios of mortality after adjusting for baseline characteristics (0.75; 95% confidence interval, 0.57-0.98) or propensity score (0.76; 95% confidence interval, 0.59-0.97). Most of the survival benefit of admission to a PCI hospital was explained by the use of PCI and evidence-based discharge medications.

Conclusions  In this prospective observational study, admission of patients with acute myocardial infarction to PCI hospitals was associated with greater use of PCI and evidence-based medications and with improved 1-year survival. Although we cannot exclude the possibility that some unmeasured confounding factors might explain the survival benefit of admission to PCI hospitals, our findings support routine use of PCI and evidence-based medications for these patients.

Author Affiliations: Techniques pour l’Evaluation et la Modélisation des Actions de Santé (ThEMAS, TIMC), National Center for Scientific Research (CNRS 5525), Université Joseph Fourier, Grenoble, France (Dr Labarere); Quality of Care Units, Centre Hospitalier Universitaire, Grenoble (Drs Labarere and Ms Fourny); Department of Cardiology, Centre Hospitalier, Annecy, France (Dr Belle); Intercontinental Medical Affairs, Sanofi-Aventis, Paris, France (Dr Genès); Department of Cardiology, Centre Hospitalier Universitaire, Lille, France (Dr Lablanche); Department of Cardiology, Clinique St Gatien, Tours, France (Dr Blanchard); Unit 558, Institut National de la Santé et de la Recherche Médicale (INSERM), Toulouse, France (Dr Cambou); and Department of Cardiology, Hôpital Européen Georges Pompidou, Paris (Dr Danchin).

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