PMID- 27659885
OWN - NLM
STAT- MEDLINE
DCOM- 20170523
LR  - 20220321
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Linking)
VI  - 180
DP  - 2016 Oct
TI  - The effect of high-risk ST elevation myocardial infarction transfer patients on 
      risk-adjusted in-hospital mortality: A report from the American Heart Association 
      Mission: Lifeline program.
PG  - 74-81
LID - S0002-8703(16)30134-X [pii]
LID - 10.1016/j.ahj.2016.07.010 [doi]
AB  - BACKGROUND: Hospital mortality is an important quality measure for acute 
      myocardial infarction care. There is a concern that despite risk adjustment, 
      percutaneous coronary intervention hospitals accepting a greater volume of 
      high-risk ST elevation myocardial infarction (STEMI) transfer patients may have 
      their reported mortality rates adversely affected. METHODS: The STEMI patients in 
      the National Cardiovascular Data RegistryAcute Coronary Treatment Intervention 
      Outcomes Network Registry-Get With the Guidelines from April 2011 to December 
      2013 were included. High-risk STEMI was defined as having either cardiogenic 
      shock or cardiac arrest on first medical contact. Receiving hospitals were 
      divided into tertiles based on the ratio of high-risk STEMI transfer patients to 
      the total number of STEMI patients treated at each hospital. Using the Action 
      Coronary Treatment Intervention Outcomes Network Registry-Get With the Guidelines 
      in-hospital mortality risk model, we calculated the difference in 
      risk-standardized in-hospital mortality before and after excluding high-risk 
      STEMI transfers in each tertile. RESULTS: Among 119,680 STEMI patients treated at 
      539 receiving hospitals, 37,028 (31%) were transfer patients, of whom 4,500 (12%) 
      were highrisk. The proportion of high-risk STEMI transfer patients ranged from 0% 
      to 12% across hospitals. Unadjusted mortality rates in the low-, middle-, and 
      high-tertile hospitals were 6.0%, 6.0%, and 5.9% among all STEMI patients and 
      6.0%, 5.5%, and 4.6% after excluding high-risk STEMI transfers. However, 
      risk-standardized hospital mortality rates were not significantly changed after 
      excluding high-risk STEMI transfer patients in any of the 3 hospital tertiles 
      (low, -0.04%; middle, -0.05%; and high, 0.03%). CONCLUSIONS: Risk-adjusted 
      in-hospital mortality rates were not adversely affected in STEMI-receiving 
      hospitals who accepted more high-risk STEMI transfer patients when a clinical 
      mortality risk model was used for risk adjustment.
CI  - Copyright (c) 2016 Elsevier Inc. All rights reserved.
FAU - Kontos, Michael C
AU  - Kontos MC
AD  - Virginia Commonwealth University, Richmond, VA. Electronic address: 
      mckontos@vcu.edu.
FAU - Wang, Tracy Y
AU  - Wang TY
AD  - DCRI, Durham, NC.
FAU - Chen, Anita Y
AU  - Chen AY
AD  - DCRI, Durham, NC.
FAU - Bates, Eric R
AU  - Bates ER
AD  - University of Michigan Cardiovascular Center, Ann Arbor, MI.
FAU - Dauerman, Harold L
AU  - Dauerman HL
AD  - Fletcher Allen Health Care, Burlington, VT.
FAU - Henry, Timothy D
AU  - Henry TD
AD  - Cedars-Sinai Heart Inst, Los Angeles, CA.
FAU - Manoukian, Steven V
AU  - Manoukian SV
AD  - Sarah Cannon Research Institute, Nashville, TN.
FAU - Roe, Matthew T
AU  - Roe MT
AD  - DCRI, Durham, NC.
FAU - Suter, Robert
AU  - Suter R
AD  - UT Southwestern University, Dallas, TX.
FAU - Thomas, Laine
AU  - Thomas L
AD  - DCRI, Durham, NC.
FAU - French, William J
AU  - French WJ
AD  - Harbor-UCLA Medical Center, Torrance, CA.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20160730
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
SB  - IM
MH  - Aged
MH  - Female
MH  - *Hospital Mortality
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Patient Transfer
MH  - Percutaneous Coronary Intervention
MH  - Registries
MH  - Risk Adjustment
MH  - ST Elevation Myocardial Infarction/*mortality/therapy
MH  - United States/epidemiology
EDAT- 2016/09/24 06:00
MHDA- 2017/05/24 06:00
CRDT- 2016/09/24 06:00
PHST- 2016/02/15 00:00 [received]
PHST- 2016/07/13 00:00 [accepted]
PHST- 2016/09/24 06:00 [entrez]
PHST- 2016/09/24 06:00 [pubmed]
PHST- 2017/05/24 06:00 [medline]
AID - S0002-8703(16)30134-X [pii]
AID - 10.1016/j.ahj.2016.07.010 [doi]
PST - ppublish
SO  - Am Heart J. 2016 Oct;180:74-81. doi: 10.1016/j.ahj.2016.07.010. Epub 2016 Jul 30.