Impact on Public HEalth of a Network in Acute Myocardial Infarction Care
Impact on Public HEalth of a Network in Acute Myocardial Infarction Care
This is a multicenter retrospective observational study with STEMI (ST Elevation Myocardial
 Infarction) patients who have been treated in the northern Galician Hospitals. The study
 tries to verify if the implantation of the PROGALIAM (Galician Assistance Program Acute
 Myocardial Infarction) has supposed a progress in the quality and expectancy of life of AMI
 patients in the north area of Galicia.

 The study will recruit STEMI patients according to the third consensus definition of
 myocardial infarction type I.

 It will include all patients who meet these criteria regardless of other demographic or
 clinical circumstances. There is not exclusion criteria defined for this population.
-  Study Hypothesis This study tries to verify if the implantation of the PROGALIAM has
 supposed a progress in the quality and expectancy of life of AMI patients in the north
 area of Galicia.

 -  Objectives.

 The study presents the following objectives:

 Primary Objectives:

 To compare morbidity rates between pre and post-PROGALIAM periods in major adverse cardiac
 events. The outcome to study is a composite of death, reinfarction, heart failure and major
 bleeding at 30 days, one year and long term follow-up.

 Secondary Objectives To compare Pre and post PROGALIAM periods regarding;

 1. Overall mortality at 30 days, one year and long term follow up. 2. Reinfarction at 30
 days, one year and long term follow up. 3. Heart failure incidence at 30 days, one year and
 long term follow up 4. Hospital major bleeding and at 30 days. 5. Hospital Vascular
 complications and at 30 days. 6. Heart failure functional Class at 30 days, one year and long
 term follow up.

 -  Study Design This is a multicenter retrospective observational study with STEMI patients
 who have been treated in the northern Galician Hospitals.

 1. Pre-PROGALIAM period: January 2001- May 2005

 2. Post-PROGALIAM period: June 2005- December 2011

 -  Rational for Sample size Sample size will be constituted by all STEMI cases occurred in
 both timeframes described above.

 According to data obtained in MASCARA register where approximately 38% of ACS patients
 present ST segment elevation, the estimated sample size would therefore be about 6100
 patients.

 *Inclusion, Exclusion Criteria and rational The study will recruit STEMI patients according
 to the third consensus definition of myocardial infarction type I. It was recently published.

 It will include all patients who meet these criteria regardless of other demographic or
 clinical circumstances. There is not exclusion criteria defined for this population.

 *Statistical analysis Categorical variables will be presented in percentage, calculated from
 the whole valid information. The CI will be of 95 %. Quantitative variables will be presented
 as mean ± standard deviation or median (interquartile range) according to a normal underlying
 distribution or not. Initially a univariate analysis will be done.

 The comparison of quantitative variables means will be done by student´s t-test in case of
 normality or by nonparametric tests in the opposite case. Categorical variables will be
 analyzed by the Chi square test. Survival will be analyzed by Kaplan-Meier curves. The
 comparison between pre and post PROGALIAM curves will be done by a log-rank test. A p <0.05
 will be considered statistically significant for two-tailed tests.

 Also there are plans to carry out a multivariate analysis. There will be a quantification of
 the adjusted effect on mortality due to the introduction of PROGALIAM by a Cox Proportional
 Hazards model. It will be defined the best model to predict this adjusted event by
 independent variables which can demonstrate an impact on death outcome in the univariate
 model and by those independent variables in which significant differences are observed
 between the pre and post PROGALIAM population. The investigators will verify if the
 implementation of the PROGALIAM is an independent predictor of survival and the impact that
 generates in the model.

 A p <0.05 result will be considered statistically significant in a two-tailed test.

 To carry out these analyses it will be necessary to have statistical software like SPSS
 and/or SAS.
Inclusion Criteria:

 -  All patients suffering STEMI (ST segment Elevation Myocardial Infarction) treated at
 Northern Galician Network of Acute Myocardial Infarction

 Exclusion Criteria:

 -  No exclusion Criteria