Abstract:
BACKGROUND:In the United States, there continues to be debate about whether certain types of hospitals deliver improved patient outcomes. We sought to assess the association between hospital organizational characteristics and in-hospital outcomes for percutaneous coronary intervention (PCI). METHODS:Retrospective analysis of 2004 to 2007 data for 694 US hospitals participating in the CathPCI Registry(®). Our analysis focused on 1,113,554 patients who underwent PCI in 471 not-for-profit (NFP) hospitals, 131 major teaching hospitals, 79 for-profit (FP) hospitals, and 13 physician-owned specialty hospitals. Outcomes included in-hospital mortality, stroke, bleeding, vascular injury, and a composite representing one or more of the individual complications. We used the current CathPCI Registry mortality risk model to calculate risk-standardized mortality ratios (RSMRs) for each category of hospital and compared hospital groupings for all patients in aggregate and in subgroups stratified by patients' indications for PCI. RESULTS:Patients treated in major teaching hospitals were younger, whereas FP hospitals performed a greater proportion of PCI for patients with ST-elevation myocardial infarction (P < .0001). Specialty hospitals treated patients with less acuity, including a lower proportion of patients with ST-elevation myocardial infarction. In unadjusted analyses, specialty hospitals had significantly lower rates of all adverse outcomes compared with NFP, teaching, and FP hospitals including in-hospital mortality (0.7%, 1.2%, 1.4%, and 1.4%, respectively; P < .001) and the composite end point (2.4%, 4.1%, 4.6%, and 4.3%, respectively; P < .001). In adjusted analyses, RSMR was significantly lower for specialty hospitals when compared with the other 3 groups for all patients in aggregate (RSMR 1.05%, 1.30%, 1.38%, 1.39%; P < .001); these differences remained clinically significant but were no longer statistically significant in subgroup analyses. CONCLUSIONS:Specialty hospitals appear to have lower rates of most adverse outcomes for PCI. Specialty hospitals may have developed expertise in narrow procedural areas that could be adapted to the larger population of general hospitals.
journal_name
Am Heart Jjournal_title
American heart journalauthors
Cram P,House JA,Messenger JC,Piana RN,Horwitz PA,Spertus JAdoi
10.1016/j.ahj.2011.10.010subject
Has Abstractpub_date
2012-02-01 00:00:00pages
222-9.e1issue
2eissn
0002-8703issn
1097-6744pii
S0002-8703(11)00770-8journal_volume
163pub_type
杂志文章,多中心研究abstract::Recent developments have provided a unique opportunity for the organization of regional ST-elevation myocardial infarction (STEMI) receiving center (SRC) networks. Because cumulative evidence has demonstrated that rapid primary percutaneous coronary intervention (PCI) is the most effective reperfusion strategy for acu...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/j.ahj.2006.06.001
更新日期:2006-10-01 00:00:00
abstract::The duration of intravenous heparin therapy required to maintain patency of the infarct-related artery after intravenous streptokinase is uncertain. Twenty-eight patients were prospectively treated with 1.5 million units of intravenous streptokinase within 4 hours of onset of chest pain. Intravenous heparin was begun ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(88)90870-8
更新日期:1988-04-01 00:00:00
abstract::The amount of cross-sectional area narrowing by atherosclerotic plaques in each 5 mm long sement of the left main, left anterior descending, left circumflex, and right coronary arteries was analyzed at necropsy in 15 patients with type II hyperlipoproteinemia (HLP), in 13 with type IV HLP, and in 10 with known normal ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(81)90383-5
更新日期:1981-01-01 00:00:00
abstract:BACKGROUND:Pregnancy is increasingly common in women with congenital heart disease (CHD), but little is known about long-term cardiovascular outcome after pregnancy in these patients. We studied the incidence of cardiovascular events 1-year postpartum and compared cardiac function prepregnancy and 1-year postpartum in ...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ahj.2014.11.010
更新日期:2015-02-01 00:00:00
abstract::Clinical and experimental evidence suggest that sympathoadrenal activation contributes to mortality in patients with ischemic heart disease. To determine the level of sympathoadrenal activation in the very early phase of acute myocardial infarction (AMI) and to determine if location of infarction (anterior versus infe...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(81)90408-7
更新日期:1981-07-01 00:00:00
abstract::To clarify the difference between alcoholic cardiomyopathy and dilated cardiomyopathy and to investigate the characteristics of alcoholic cardiomyopathy, right ventricular endomyocardial biopsy was performed, and the two diseases were compared clinically and histologically. Changes in the cardiothoracic ratio, cardiac...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(93)90175-9
更新日期:1993-03-01 00:00:00
abstract::Fifteen cases of the sick-sinus syndrome in young Negroes are presented. The etiology was unknown in all cases; organic heart disease was absent. The very high default rate suggests that the prognosis may be grave. This disorder is by no means uncommon in young persons in tropical countries and the dangers of a mistak...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(75)90078-2
更新日期:1975-03-01 00:00:00
abstract::Coronary arterial stenosis of varying severity and length were created in open-chest dogs. The reactive hyperemic responses (RHR) to 15 second occlusions were used to produce flow increases and judge the physiological significance of the narrowings. RHR are sensitive indices of functional impairment when resting flow ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(76)80010-5
更新日期:1976-12-01 00:00:00
abstract:BACKGROUND:The study rationale was to compare the biomarker profile of metalloproteinases (MMPs) and inflammation markers (IMs) in patients requiring revascularization with that of patients with long-term, clinically quiescent coronary artery disease (CAD). METHODS:Seventy-eight patients with symptomatic CAD (S-CAD) (...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2007.08.021
更新日期:2008-01-01 00:00:00
abstract::Calcium channel blockers and central alpha-agonists are among the classes of antihypertensive drugs that yield the most favorable overall effects on risk factors for hypertension-related end-organ damage. An open-label prospective trial in 42 patients with a mean baseline blood pressure of 144/102 mm Hg sought to asse...
journal_title:American heart journal
pub_type: 临床试验,杂志文章
doi:10.1016/0002-8703(93)90707-g
更新日期:1993-10-01 00:00:00
abstract::The Magnum/Magnarail system consists of "over-the-wire" balloon catheters and a 0.021 inch (0.53 mm) guide wire with a 1 mm olive-shaped tip. To compare it to conventional systems, 100 consecutive unselected patients with chronic total coronary occlusions were randomly assigned to one of two groups. If the balloon cou...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0002-8703(92)91020-2
更新日期:1992-05-01 00:00:00
abstract::Dobutamine (and dopamine) are potent positive inotropic drugs which are frequently given to treat decompensated congestive heart failure. This study reports on the use of ambulatory dobutamine (and dopamine) infusions in 21 outpatients with advanced congestive heart failure. Each patient was initially hospitalized, an...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(87)90757-5
更新日期:1987-09-01 00:00:00
abstract::Nearly 800,000 of the 1 million patients hospitalized with acute heart failure (AHF) every year are initially treated by emergency physicians. Signs and symptoms are typically most severe at initial presentation, but with timely diagnostic and therapeutic management, rapid improvement can be achieved. As a direct resu...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/j.ahj.2013.03.009
更新日期:2013-06-01 00:00:00
abstract::The effects of 20 variables that might influence postmyocardial infarction prognosis were assessed retrospectively in 139 patients followed up for an average of 11 months after discharge from San Francisco General Hospital following an acute myocardial infarction. When these variables were analyzed with the use of mul...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(85)90501-0
更新日期:1985-07-01 00:00:00
abstract::In a demographic study, the black Ohio residents were characterized by those born in Ohio and those born in other regions of the United States, and comparisons were made of rates for all deaths (1960-1967) for coronary heart disease (420), endocarditis and myocardial degeneration (421-422), hypertensive cardiovascular...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(75)90329-4
更新日期:1975-09-01 00:00:00
abstract::While the total ischemic burden on the left ventricle represents the combined effects of both symptomatic and asymptomatic myocardial ischemia, the total vascular burden has many components including an increased systemic peripheral vascular resistance, an increased pulmonary vascular resistance, and an increased coro...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/0002-8703(88)90551-0
更新日期:1988-01-01 00:00:00
abstract::A new agent for use in contrast echocardiography that is capable of passing through the pulmonary circulation and opacifying the left ventricular cavity after intravenous injection was evaluated in a canine model. Air-filled albumin microbubbles were produced by sonication. A Coulter counter was used to size and count...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(87)90754-x
更新日期:1987-09-01 00:00:00
abstract::The American Cancer Society's prospective study of 1 million Americans was analyzed to determine whether coronary heart disease (CHD) mortality rates by cigarette smoking in blacks differed from those in whites. More than 22,000 blacks were followed up for nearly 200,000 person-years in the 12-year study, 1960-1972. A...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(84)90675-6
更新日期:1984-09-01 00:00:00
abstract::In 72 patients who received streptokinase within 6 hours of the onset of an acute myocardial infarction (AMI), the relationship between the presence of a previous coronary event and the severity of the residual coronary artery stenosis was studied. Fifty-five patients were either asymptomatic or had recent onset angin...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(89)90219-6
更新日期:1989-11-01 00:00:00
abstract::Controlled versus uncontrolled reperfusion of ischemic myocardium after experimental coronary artery occlusion was studied to determine the effect on regional ventricular wall motion and associated biochemical alterations. Fourteen pigs underwent coronary artery occlusion for 1 hour followed by 2 hours of reperfusion....
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(89)90723-0
更新日期:1989-03-01 00:00:00
abstract::The objective of this investigation was to assess the acute and long-term outcome after coronary angioplasty in patients undergoing chronic hemodialysis. Previous studies have suggested a high incidence of restenosis after coronary angioplasty performed in patients with renal failure. Medical discharge abstracts for 8...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(94)90476-6
更新日期:1994-08-01 00:00:00
abstract:BACKGROUND:Patients with atrial fibrillation (AF) are at increased risk for ischemic stroke. In patients who have suffered a stroke, screening for AF is routinely performed only for a short period after the stroke as part of the evaluation for possible causes. If AF is detected after an ischemic stroke, oral anticoagul...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.ahj.2010.03.032
更新日期:2010-07-01 00:00:00
abstract::The hemodynamic effects of dopamine (DPM) and dobutamine (DBM) were compared in 13 patients with acute cardiogenic circulatory collapse. All patients presented with acute pump failure and inadequate systemic perfusion, and most were hypotensive. Nine patients had an acute myocardial infarction (AMI); the other four pa...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0002-8703(82)90562-2
更新日期:1982-06-01 00:00:00
abstract::Atrial depressurization time measurement by Doppler ultrasound can be used to quantify stenotic mitral valve area. In this report, we present the results of a blinded trial comparing the standard Doppler method for "pressure half-time" (A) and another Doppler method we devised (B) for measurement of atrial depressuriz...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0002-8703(87)90045-7
更新日期:1987-04-01 00:00:00
abstract::In a double-blind, randomized crossover study of 12 patients suffering from chronic bronchitis, the comparative influence of equipotent doses of pindolol (5 mg) and metoprolol (100 mg) on the bronchodilatory potential of inhaled fenoterol (0.4 mg), a beta 2-agonist, was investigated by means of body plethysmography. N...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0002-8703(82)90138-7
更新日期:1982-08-01 00:00:00
abstract::It has been shown that brief episodes of myocardial ischemia can render the heart more resistant to a prolonged subsequent ischemic episode. This phenomenon, called "preconditioning," has been described in human beings during coronary angioplasty with the use of clinical, electrocardiographic (ECG), or metabolic param...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(97)70200-x
更新日期:1997-04-01 00:00:00
abstract::Compared with pathologic studies coronary angiography is a relatively insensitive technique to detect early atherosclerosis. Coronary angioscopy is a new technique providing direct information on luminal vessel surface. To determine whether coronary angioscopy may detect the presence of atherosclerotic disease on angi...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(95)90198-1
更新日期:1995-11-01 00:00:00
abstract::We investigated the incidence and mechanism of pulmonary artery hypertension (PAH) in a consecutive series of patients with aortic stenosis who were undergoing diagnostic cardiac catheterization. Forty-five patients with severe aortic stenosis were divided into two groups: group 1 comprised 13 patients (29%) with PAH ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(93)90067-j
更新日期:1993-01-01 00:00:00
abstract::The development of ECG Minnesota Q-QS codes and their subsequent evolution were studied in the first 692 subjects to enter the POSCH program who had had one MI. The mean interval from MI to entry into the study was 2.2 years. Sixty-three percent of the subjects developed the most significant code with the infarction. ...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0002-8703(85)90169-3
更新日期:1985-08-01 00:00:00
abstract:BACKGROUND:Moderate alcohol drinking and marine omega-3 fatty acids (omega3) have both been associated with low mortality from coronary heart disease (CHD). However, there is little data evaluating the interactions of wine ethanol drinking with omega3 in CHD patients. METHODS:The relationships between wine drinking an...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2007.08.009
更新日期:2008-01-01 00:00:00