The Impact of American College of Cardiology Chest Pain Center Accreditation on Guideline Recommended Acute Myocardial Infarction Management

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Crit Pathw Cardiol


BACKGROUND: Whether American College of Cardiology (ACC) Chest Pain Center (CPC) accreditation alters guidelines adherence rates is unclear.

METHODS: We analyzed patient-level, hospital-reported, quality metrics for myocardial infarction (MI) patients from 644 hospitals collected in the ACC's Chest Pain-MI Registry from 1/1/19 to 12/31/20, stratified by CPC accreditation for >1 year.

RESULTS: Of 192,374 MI patients, 67,462 (35.1%) received care at an accredited hospital. In general, differences in guideline adherence rates between accredited and non-accredited hospitals were numerically small, though frequently significant. Patients at accredited hospitals were more likely to undergo coronary angiography (98.6% vs 97.9%, p<0.0001), percutaneous coronary intervention (PCI) for NSTEMI (55.4% vs 52.3%, p<0.0001), have overall revascularization for NSTEMI (63.5% vs 61.0%, p<0.0001), and receive P2Y12 inhibitor on arrival (63.5% vs. 60.2%, p<0.0001). Non-accredited hospitals more ECG within 10 minutes (62.3% vs. 60.4%, p<0.0001) and first medical contact to device activation ≤ 90 minutes (66.8% vs. 64.8%, p<0.0001). Accredited hospitals had uniformly higher discharge medication guideline adherence, with patients more likely receiving aspirin (97.8% vs. 97.4%, p<0.0001), angiotensin converting enzyme inhibitor (46.7% vs. 45.3%, p<0.0001), beta blocker (96.6% vs. 96.2%, p<0.0001), P2Y12 inhibitor (90.3% vs. 89.2%, p<0.0001), and statin (97.8% vs. 97.5%, p<0.0001). Interaction by accredited status was significant only for length of stay (LOS), which was slightly shorter at accredited facilities for specific subgroups.

CONCLUSIONS: ACC CPC accreditation was associated with small consistent improvement in adherence to guideline-based treatment recommendations of catheter-based care (catheterization and PCI) for NSTEMI and discharge medications, and shorter hospital stays.

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ePub ahead of print