Providing optimal care for STEMI
Choosing the best course of care for ST-segment elevation myocardial infarction (STEMI) requires the coordination of various services, including prehospital emergency medical services, emergency medicine and interventional cardiology. Although primary percutaneous coronary intervention (PCI) is considered the best therapy for STEMI, it may not be available at all centres. This study describes the clinical management and health outcomes of 2247 patients admitted to hospital for STEMI over a three-year period in southern Ontario, Canada. Patients presenting to the region’s PCI-capable hospital were more likely to receive primary PCI (82.5% v. 65.2%, p < 0.001) and to be treated within optimal treatment times than those initially presenting to a centre not capable of PCI (Table 1). However, there was no significant difference in mortality rates by type of centre. A systematic approach to regional STEMI care focusing on timely access to the best available therapies, rather than the type of reperfusion provided alone, can yield favourable outcomes, say the authors. CMAJ Open 2015; 3:E1–7
Risk factors for death among patients with Staphylococcus aureus bacteremia
Staphylococcus aureus is one of the leading causes of hospital-acquired infections, and rates of infections are increasing steadily in North America. In this retrospective cohort study set in a tertiary care Canadian hospital, the all-cause mortality rate associated with S. aureus bacteremia was 28%. Between 2008 and 2012, 925 patients were admitted with S. aureus bacteremia, 21% died in hospital and 7% died within 90 days after discharge.
Risk factors associated with all-cause and in-hospital mortality included age, sepsis, admission to the intensive care unit, hepatic failure and metastatic cancer (Table 2). Several factors (i.e., methicillin resistance, hepatic failure, cerebrovascular disease, chronic obstructive pulmonary disease and metastatic cancer) were associated with higher mortality rates after discharge. CMAJ Open 2014;2:E352–9