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Heart Attack Outcomes May Be Better With On-Site Surgery

Study suggests lower risk of death is due to both modifiable and non-modifiable factors

THURSDAY, Oct. 22 (HealthDay News) -- Patients with non-ST-segment elevation myocardial infarction (NSTEMI) have better outcomes if they present to a hospital with on-site cardiac surgery, according to a study in the October issue of the Journal of the American College of Cardiology: Cardiovascular Interventions.

Yuri B. Pride, M.D., of Harvard Medical School in Boston, Massachusetts, and colleagues analyzed data from 100,071 patients with NSTEMI to determine whether the presence of on-site cardiac surgery at a hospital affected outcomes and to determine outcomes among patients who underwent percutaneous coronary intervention (PCI).

The researchers found that patients presenting to sites with cardiac surgery had significantly lower mortality, even in a propensity-matched model (5.9 versus 8.5 percent). These patients were also significantly more likely to receive guideline-recommended medications (aspirin, beta blockers, and statins) within the first 24 hours and to undergo PCI. However, after adjusting for medication differences and hospital characteristics, the lower mortality was borderline significant (hazard ratio, 0.89). Restricting the propensity-matched model to patients undergoing PCI showed no significant difference in mortality based on hospital type.

"Patients with NSTEMI presenting to hospitals without backup cardiac surgery have significantly higher in-hospital mortality, even after adjusting for differences in baseline patient characteristics," Pride and colleagues conclude. "This appears to be due to both modifiable (lower use of guideline-recommended medications) and non-modifiable factors (hospital size, myocardial infarction volume)."

The National Registry of Myocardial Infarction is supported by Genentech Inc.

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