PMID- 26510808
OWN - NLM
STAT- MEDLINE
DCOM- 20160212
LR  - 20191210
IS  - 1326-5377 (Electronic)
IS  - 0025-729X (Linking)
VI  - 203
IP  - 9
DP  - 2015 Nov 2
TI  - Survival after an acute coronary syndrome: 18-month outcomes from the Australian 
      and New Zealand SNAPSHOT ACS study.
PG  - 368
AB  - OBJECTIVES: To assess the impact of the availability of a catheterisation 
      laboratory and evidence-based care on the 18-month mortality rate in patients 
      with suspected acute coronary syndromes (ACS). DESIGN, SETTING AND PARTICIPANTS: 
      Management and outcomes are described for patients enrolled in the 2012 
      Australian and New Zealand SNAPSHOT ACS audit. Patients were stratified according 
      to their presentation to hospitals with or without cardiac catheterisation 
      facilities. Data linkage ascertained patient vital status 18 months after 
      admission. Descriptive and Cox proportional hazards analyses determined 
      predictors of outcomes, and were used to estimate the numbers of deaths that 
      could be averted by improved application of evidence-based care. MAIN OUTCOME 
      MEASURES: Mortality for ACS patients from admission to 18 months after admission. 
      RESULTS: Definite ACS patients presenting to catheterisation-capable (CC) 
      hospitals (n = 1326) were more likely to undergo coronary angiography than those 
      presenting to non-CC hospitals (n = 1031) (61.5% v 50.8%; P = 0.0001), receive 
      timely reperfusion (for ST elevation myocardial infarction (STEMI) patients: 
      45.2% v 19.2%; P < 0.001), and be referred for cardiac rehabilitation (57% v 53%; 
      P = 0.05). All-cause mortality over 18 months was highest for STEMI (16.2%) and 
      non-STEMI (16.3%) patients, and lowest for those presenting with unstable angina 
      (6.8%) and non-cardiac chest pain (4.8%; P < 0.0001 for trend). After adjustment 
      for patient propensity to present to a CC hospital and patient risk, presentation 
      to a CC hospital was associated with 21% (95% CI, 2%-37%) lower mortality than 
      presentation to a non-CC hospital. This mortality difference was attenuated after 
      adjusting for delivery of evidence-based care. CONCLUSION: In Australia and New 
      Zealand, the availability of a catheterisation laboratory appears to have a 
      significant impact on long-term mortality in ACS patients, which is still 
      substantial. This mortality may be reduced by improvements in evidence-based care 
      in both CC and non-CC hospitals.
FAU - Brieger, David B
AU  - Brieger DB
AD  - Concord Repatriation General Hospital, Sydney, NSW 
      david.brieger@sswahs.nsw.gov.au.
FAU - Chew, Derek P B
AU  - Chew DP
AD  - Flinders Medical Centre, Adelaide, SA.
FAU - Redfern, Julie
AU  - Redfern J
AD  - The George Institute for Global Health, University of Sydney, Sydney, NSW.
FAU - Ellis, Chris
AU  - Ellis C
AD  - Auckland City Hospital, Auckland, New Zealand.
FAU - Briffa, Tom G
AU  - Briffa TG
AD  - The University of Western Australia, Perth, WA.
FAU - Howell, Tegwen E
AU  - Howell TE
AD  - Concord Repatriation General Hospital, Sydney, NSW.
FAU - Aliprandi-Costa, Bernadette
AU  - Aliprandi-Costa B
AD  - University of Sydney, Sydney, NSW.
FAU - Astley, Carolyn M
AU  - Astley CM
AD  - Flinders Medical Centre, Adelaide, SA.
FAU - Gamble, Greg
AU  - Gamble G
AD  - University of Auckland, Auckland, New Zealand.
FAU - Carr, Bridie
AU  - Carr B
AD  - Cardiac Network Agency for Clinical Innovation, Sydney, NSW.
FAU - Hammett, Christopher J K
AU  - Hammett CJ
AD  - Concord Repatriation General Hospital, Sydney, NSW.
FAU - Board, Neville
AU  - Board N
AD  - Concord Repatriation General Hospital, Sydney, NSW.
FAU - French, John K
AU  - French JK
AD  - Concord Repatriation General Hospital, Sydney, NSW.
LA  - eng
PT  - Journal Article
PL  - Australia
TA  - Med J Aust
JT  - The Medical journal of Australia
JID - 0400714
SB  - IM
MH  - Acute Coronary Syndrome/diagnosis/*mortality/therapy
MH  - Aged
MH  - Aged, 80 and over
MH  - Australia
MH  - *Cardiac Care Facilities
MH  - *Cardiac Catheterization
MH  - Coronary Angiography
MH  - Female
MH  - *Health Services Accessibility
MH  - Hospitalization
MH  - Humans
MH  - Male
MH  - Medical Audit
MH  - Middle Aged
MH  - New Zealand
MH  - Outcome Assessment, Health Care
MH  - Survival Analysis
EDAT- 2015/10/30 06:00
MHDA- 2016/02/13 06:00
CRDT- 2015/10/30 06:00
PHST- 2015/04/26 00:00 [received]
PHST- 2015/09/07 00:00 [accepted]
PHST- 2015/10/30 06:00 [entrez]
PHST- 2015/10/30 06:00 [pubmed]
PHST- 2016/02/13 06:00 [medline]
AID - 10.5694/mja15.00504 [pii]
AID - 10.5694/mja15.00504 [doi]
PST - ppublish
SO  - Med J Aust. 2015 Nov 2;203(9):368. doi: 10.5694/mja15.00504.