Bebb, OwenHall, MarlousFox, Keith A. A.Dondo, Tatendashe B.Timmis, AdamBueno, HectorSchiele, FrancoisGale, Chris P.2017-10-202017-10-202017Eur Heart J. 2017; 38(13):974-9820195-668Xhttp://hdl.handle.net/20.500.12105/5157Aims To investigate the application of the European Society of Cardiology Acute Cardiovascular Care Association quality indicators (QI) for acute myocardial infarction for the study of hospital performance and 30-day mortality. Methods and results National cohort study (n = 118,075 patients, n = 211 hospitals, MINAP registry), 2012-13. Overall, 16 of the 20 QIs could be calculated. Eleven QIs had a significant inverse association with GRACE risk adjusted 30-day mortality (all P < 0.005). The association with the greatest magnitude was high attainment of the composite opportunity-based QI (80-100\%) vs. zero attainment (odds ratio 0.04, 95\% confidence interval 0.04-0.05, P < 0.001), increasing attainment from low (0.42, 0.37-0.49, P < 0.001) to intermediate (0.15, 0.13-0.16, P < 0.001) was significantly associated with a reduced risk of 30-day mortality. A 1\% increase in attainment of this QI was associated with a 3\% reduction in 30-day mortality (0.97, 0.97-0.97, P < 0.001). The QI with the widest hospital variation was 0fondaparinux received among NSTEMI0 (interquartile range 84.7\%) and least variation 0centre organisation0 (0.0\%), with seven QIs depicting minimal variation (< 11\%). GRACE risk score adjusted 30-day mortality varied by hospital (median 6.7\%, interquartile range 5.4-7.9\%). Conclusions Eleven QIs were significantly inversely associated with 30-day mortality. Increasing patient attainment of the composite quality indicator was the most powerful predictor; a 1\% increase in attainment represented a 3\% decrease in 30day standardised mortality. The ESC QIs for acute myocardial infarction are applicable in a large health system and have the potential to improve care and reduce unwarranted variation in death from acute myocardial infarction.engVoRhttp://creativecommons.org/licenses/by/4.0/Quality indicatorsAcute myocardial infarctionMortalityHospital performanceACUTE MYOCARDIAL-INFARCTIONPERCUTANEOUS CORONARY INTERVENTIONST-SEGMENT ELEVATIONEUROPEAN COUNTRIESTERM MORTALITYCAREDETERMINANTSMANAGEMENTADHERENCEKINGDOMAtribución 4.0 Internacional2832927938974-98210.1093/eurheartj/ehx0081522-9645European Heart Journalopen access