Table 2.
Quality Indicators and Outcomes
| Quality Indicators | Missing | Total, n (%) | Hospitals Categorized According to Hospital‐Level Annual PPCI Volume | P Value | ||
|---|---|---|---|---|---|---|
| Low Volume | Medium Volume | High Volume | ||||
| Timeliness | ||||||
| Total ischemic time, median (25th–75th percentile), h | 42 | 3.9 (2.7–6.1) | 3.5 (2.4–5.5) | 3.8 (2.6–6.1) | 4.2 (2.8–6.3) | 0.01 |
| ECG‐to‐balloon time, median (25th–75th percentile), h | 11 | 1.8 (1.1–3.0) | 1.5 (1.0–2.4) | 1.5 (0.8–2.8) | 2 (1.2–3.1) | 0.01 |
| Door‐to‐balloon time, median (25th–75th percentile), h | 7 | 1.2 (0.8–1.7) | 1.2 (0.9–1.7) | 1.16 (0.8–1.9) | 1.13 (0.8–1.6) | 0.60 |
| Symptom onset to first medical contact, median (25th–75th percentile), h | 0 | 1.5 (0.8–3.0) | 1.33 (0.7–3.0) | 1.5 (0.8–3.0) | 1.5 (0.9–3.0) | 0.96 |
| Procedural characteristics, n (%) | ||||||
| Radial access | 0 | 3572 (64.2) | 609 (61.5) | 652 (71.3) | 2311 (63.2) | 0.01 |
| Aspiration thrombectomy use | 0 | 2062 (37.1) | 448 (45.2) | 343 (37.5) | 1271 (34.8) | 0.01 |
| TIMI flow III final | 0 | 5190 (93.3) | 912 (92.1) | 853 (93.2) | 3425 (93.7) | 0.08 |
| Nonculprit vessel PCI during index admission | 0 | 359 (6.5) | 68 (6.9) | 91 (9.9) | 200 (5.5) | 0.01 |
| Discharge medications, n (%) | ||||||
| Aspirin | 8 | 5269 (98.5) | 918 (96.5) | 895 (99.4) | 3456 (98.8) | 0.01 |
| Clopidogrel | 7 | 3911 (73.1) | 630 (66.3) | 730 (81.1) | 2551 (72.9) | 0.01 |
| Ticagrelor | 8 | 847 (15.8) | 246 (25.9) | 109 (12.1) | 492 (14.1) | 0.01 |
| Prasugrel | 8 | 563 (10.5) | 68 (7.1) | 57 (6.3) | 438 (12.5) | 0.01 |
| High‐intensity statin | 8 | 5120 (95.7) | 875 (92.0) | 826 (91.8) | 3419 (97.7) | 0.01 |
| β Blocker | 9 | 3497 (65.4) | 649 (68.2) | 570 (63.3) | 2278 (65.1) | 0.16 |
| ACEI or ARB in patients with documented LV systolic dysfunction | 7 | 1321 (50.6) | 226 (37.7) | 109 (25.8) | 986 (62.1) | 0.01 |
| Aldactone | 213 | 825 (14.8) | 71 (7.2) | 111 (12.1) | 643 (17.6) | 0.01 |
| Eplerenone | 213 | 109 (2.0) | 11 (1.1) | 3 (0.3) | 95 (2.6) | 0.01 |
| Outcomes | ||||||
| Stent thrombosis, n (%) | 7 | 110 (2.0) | 16 (1.6) | 9 (1) | 85 (2.3) | 0.04 |
| Definite stent thrombosis, n (%) | 7 | 44 (0.8) | 9 (0.9) | 5 (0.5) | 30 (0.8) | 0.03 |
| TIMI major bleed, n (%) | 6 | 32 (0.6) | 2 (0.2) | 4 (0.4) | 26 (0.7) | 0.01 |
| LVEF, mean (SD), % | 270 | 39.2 (14.6) | 32.8 (13.9) | 39.6 (16.4) | 40.8 (13.8) | 0.01 |
| Cardiogenic shock, in hospital, n (%) | 7 | 363 (6.5) | 50 (5.1) | 30 (3.3) | 283 (7.7) | 0.01 |
| 30‐d Mortality, n (%) | 0 | 234 (4.2) | 44 (4.4) | 20 (2.2) | 170 (4.6) | 0.01 |
| 1‐y Mortality, n (%) | 0 | 410 (7.4) | 64 (6.5) | 31 (3.4) | 315 (8.6) | 0.01 |
ACEI indicates angiotensin‐converting enzyme inhibitor; ARB, aldosterone receptor blocker; LV, left ventricular; LVEF, LV ejection fraction; PCI, percutaneous coronary intervention; PPCI, primary PCI; and TIMI, Thrombolysis in Myocardial Infarction.