Intercenter variability in outcome for patients treated with direct coronary angioplasty during acute myocardial infarction.
Background Direct coronary angioplasty is an effective therapy for acute myocardial infarction, but its success may be dependent on both ready availability and operator skill.
The purpose of this study was to investigate the impact of the center performing direct coronary angioplasty for acute myocardial infarction while controlling for parameters known to affect outcome.
Methods and Results The study group consisted of 99 patients with ST elevation who were treated with direct angioplasty in four high-volume centers.
Patients were injected with technetium-99m sestamibi intravenously and then taken to the cardiac catheterization laboratory.
Antegrade flow was graded before and after direct coronary angioplasty.
Single photon emission computed tomography was performed 1 to 6 hours after injection to measure myocardium at risk and residual blood flow to the jeopardized zone using previously published quantitative methods.
A repeat sestamibi injection and tomographic acquisition were performed at hospital discharge to measure actual infarct size.
There were no significant differences by center for baseline clinical characteristics, mean myocardium at risk (29% to 37% left ventricle [LV]), time to reperfusion (3.1 to 4.1 hours), residual blood flow, infarct location, or antegrade flow.
Despite these similarities, there were differences in outcome measures by center.
Mean infarct size was as follows :
center 1,15% ;
center 2,12% ;
center 3,10%, center 4,23%. (...)
Mots-clés Pascal : Infarctus, Myocarde, Homme, Dilatation instrumentale, Artère coronaire, Pronostic, Comparaison interindividuelle, Hôpital, Qualité, Soin, Appareil circulatoire pathologie, Cardiopathie coronaire, Myocarde pathologie, Traitement instrumental
Mots-clés Pascal anglais : Infarct, Myocardium, Human, Instrumental dilatation, Coronary artery, Prognosis, Interindividual comparison, Hospital, Quality, Care, Cardiovascular disease, Coronary heart disease, Myocardial disease, Instrumentation therapy
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0150542
Code Inist : 002B26E. Création : 21/07/1998.