Author + information
- Received January 24, 2019
- Revision received June 21, 2019
- Accepted June 27, 2019
- Published online September 9, 2019.
- Héctor Bueno, MD, PhDa,b,c,∗ (, )@CNIC_CARDIO,
- Xavier Rossello, MD, PhDa,d,e@RosselloXavier,
- Stuart J. Pocock, PhDd,
- Frans Van de Werf, MD, PhDf,
- Chee Tang Chin, MDg,
- Nicolas Danchin, MD, PhDh,
- Stephen W.-L. Lee, MD, PhDi,
- Jesús Medina, PhDj and
- Yong Huo, MD, PhDk
- aCentro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- bInstituto de Investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- cFacultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
- dLondon School of Hygiene and Tropical Medicine, London, United Kingdom
- eCIBER de Enfermedades CardioVasculares, Madrid, Spain
- fDepartment of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- gNational Heart Centre Singapore, Singapore
- hHôpital Européen Georges Pompidou & René Descartes University, Paris, France
- iQueen Mary Hospital, Hong Kong SAR, China
- jGlobal Medical Affairs, AstraZeneca, Madrid, Spain
- kBeijing University First Hospital, Beijing, China
- ↵∗Address for correspondence:
Dr. Héctor Bueno, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernandez Almagro, 3, 28029-Madrid, Spain.
Background The relationship between in-hospital coronary revascularization rate (CRR) and post-discharge mortality rates in survivors of non–ST-segment elevation acute coronary syndrome (NSTE-ACS) at a system level is unclear.
Objectives The purpose of this study was to evaluate CRR and 2-year post-discharge mortality rate (2YMR) in NSTE-ACS.
Methods CRR and 2YMR were analyzed by hospital rate of CRR (in deciles), by country, and by world region in 11,931 patients with NSTE-ACS who survived to discharge and were enrolled in the EPICOR (long-tErm follow uP of antithrombotic management patterns In acute CORonary syndrome patients) and EPICOR Asia: twin multinational, observational, prospective cohort studies.
Results Significant differences in patient baseline characteristics, medical therapies, CRR, and 2YMR were found. Mean CRR ranged from 0.0% to 96.8% in the first and tenth decile, respectively (p < 0.001); from 12.3% in Romania to 92.4% in Slovenia (p < 0.001); and from 53.9% in South East Asia (SEAsia) to 90.4% in South Korea–Singapore–Hong Kong. 2YMR varied significantly between hospital deciles of CRR (3.6% in tenth decile vs. 9.2% in first decile; p < 0.001), countries (lowest 1.5% in Slovenia, highest 19.4% in Malaysia; p < 0.001), and regions (lowest 3.8% in South Korea–Singapore–Hong Kong, highest 11.7% in SEAsia; p < 0.001). Poisson regression models, adjusted for 15 mortality predictors, showed a significant inverse association between CRR and 2YMR for hospitals (r = −0.90; p < 0.001), countries (r = −0.65; p < 0.001), and regions (r = −0.87; p = 0.005).
Conclusions Higher CRRs at the hospital, country, and world region levels are strongly associated with higher post-discharge survival, suggesting CRR as a marker of higher system quality.
The EPICOR and EPICOR Asia studies were funded by AstraZeneca. The CNIC is supported by the Spanish Ministry of Economy and Competitiveness (MINECO) and the Pro-CNIC Foundation, and is a Severo Ochoa Center of Excellence (MINECO award SEV-2015-0505). Dr. Bueno has received research funding from the Instituto de Salud Carlos III, Spain (PIE16/00021 and PI17/01799), AstraZeneca, Bristol-Myers Squibb, Janssen, and Novartis; has received consulting fees from AstraZeneca, Bayer, Bristol-Myers Squibb-Pfizer, and Novartis; and has received speaker fees or support for attending scientific meetings from AstraZeneca, Bayer, Bristol-Myers Squibb-Pfizer, Ferrer, Novartis, and MEDSCAPE-the heart.org. Dr. Rossello has received support from the SEC-CNIC CARDIOJOVEN fellowship program. Dr. Pocock has received research funding from AstraZeneca. Dr. Van de Werf has received consulting fees and research grants from Boehringer Ingelheim, Merck, and Sanofi; and has received consulting and speaker fees from Boehringer Ingelheim, Roche, Sanofi, AstraZeneca, and The Medicines Company. Dr. Chin has received consulting or speaker fees from AstraZeneca, Merck, Servier, and Medtronic. Dr. Danchin has received consulting or speaker fees from Amgen, AstraZeneca, Bayer, Bristol-Myers Squibb, Boehringer Ingelheim, Merck Sharp & Dohme, Novo Nordisk, Pfizer, Sanofi, and Servier. Dr. Medina is an employee of AstraZeneca. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Deepak Bhatt, MD, served as Guest Editor-in-Chief for this paper.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received January 24, 2019.
- Revision received June 21, 2019.
- Accepted June 27, 2019.
- 2019 American College of Cardiology Foundation
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