Differences of Early Management of Patients with Acute Myocardial Infarction between Hospitals with and without Coronary Revascularization Facilities

BACKGROUND AND OBJECTIVES: Fibrinolytic therapy or percutaneous coronary intervention are different forms of reperfusion therapy for an acute myocardial infarction. The aim of this study was to assess the differences in the early managements, including reperfusion therapy and inhospital outcomes, of patients with acute myocardial infarction (MI) between hospitals with and without coronary revascularization facilities.

SUBJECTS AND METHODS: The clinical characteristics, reperfusion therapy, initial medical treatments, frequency of invasive and non-invasive studies and inhospital mortalities of 962 and 433 acute myocardial infarction patients in hospitals with and without coronary revascularization facilities, respectively, between 1995 and 2000, were retrospectively compared.

RESULTS: There were no differences in the clinical characteristics between two groups. There was also no difference in the rate of reperfusion therapy between two groups (57.9 vs. 58.0 %, p=NS). Patients in hospitals with coronary revascularization facilities more often underwent coronary angiography (18.9 vs. 61.4%, p<0.01), but less often underwent stress tests (162 vs. 40.5%, p0.05). The hospital mortalities were 9.7 and 9.8%, respectively, in hospitals with and without coronary revascularization facilities (p=NS).

CONCLUSION: Those patients with acute MI admitted to hospital without coronary revascularization facilities appear to have a similar likelihood of receiving reperfusion therapy and other medications, including aspirin and beta-blockers, and similar inhospital outcomes to those admitted to hospitals with such facilities.