Abstract
Background/Objectives
This study assesses adherence to performance measures for acute myocardial infarction
(AMI) in six Middle-Eastern countries, and its association with in-hospital mortality.
Few studies have previously assessed these performance measures in the Middle East.
Methods
This cohort study followed 5813 patients with suspected AMI upon admission to discharge.
Proportions of eligible participants receiving the following performance measures
were calculated: medications within 24 hours of admission (aspirin and beta-blocker)
and on discharge (aspirin, beta-blockers, angiotensin converting enzyme inhibitors
[ACEI], and lipid-lowering therapy), reperfusion therapy, and low-density lipoprotein
(LDL) cholesterol measurement. A composite adherence score was calculated. Associations
between performance measures and clinical characteristics were assessed using multivariate
logistic regression.
Results
Adherence was above 90% for aspirin, reperfusion, and lipid-lowering therapies; between
60% and 82% for beta-blockers, ACEI, statin therapy, time-to-balloon within 90 minutes,
and LDL-cholesterol measurement; and 33% for time-to-needle within 30 minutes. After
adjustment, factors associated with high composite performance score (>85%) included Asian ethnicity (Odds Ratio, OR=1.3; p=0.01) and history of hyperlipidemia (OR=1.4; p=0.001). Factors associated with a lower score included atypical symptoms (OR=0.6; p=0.003) and high GRACE score (OR=0.6; p<0.001). Lower in-hospital mortality was associated with provision of reperfusion therapy
(OR=0.54, p=0.047) and beta-blockers within 24 hours (OR=0.33, p=0.005).
Conclusions
Overall adherence was lowest among the highest-risk patients. Lower in-hospital mortality
was independently associated with adherence to early performance measures, comprising
observational evidence for their effectiveness in a Middle East cohort. These data
provide a focus for regional quality improvement initiatives and research.
Abbreviations:
ACC/AHA (American College of Cardiology/American Heart Association), ACEI (Angiotensin converting enzyme inhibitor), AMI (Acute myocardial infarction), Gulf RACE (Gulf Registry of Acute Coronary Events), LBBB (Left bundle branch block), NCDR (National Cardiovascular Data Registry), NSTEMI (Non-ST elevation myocardial infarction), PCI (Primary percutaneous coronary intervention), STEMI (ST elevation myocardial infarction)Keywords
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Article info
Publication history
Published online: May 11, 2012
Accepted:
April 8,
2012
Received in revised form:
February 23,
2012
Received:
September 27,
2011
Identification
Copyright
© 2012 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
