Long-term outcomes after acute myocardial infarction in countries with different socioeconomic environments: an international prospective cohort study

Kämpfer, Judith; Yagensky, A.; Zdrojewski, Tomasz; Windecker, Stephan; Meier, Bernhard; Pavelko, Mykhailo; Sichkaruk, I.; Kasprzyk, Piotr; Gruchała, Marcin; Giacomini, Mikael; Raber, L; Saner, Hugo

doi:10.1136/bmjopen-2016-012715

Cited by 16 publications

(19 citation statements)

References 28 publications

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“…Cardiovascular diseases pose a significant disease burden worldwide and are associated with considerable years of life lost, particularly in low-and middle-income countries [1,2]. Given similar care settings and implementation of international guidelines, the long-term mortality following the first episode of acute myocardial infarction (AMI) was more than three-fold higher in developing countries as compared to that in European continents [3].…”

Section: Introductionmentioning

confidence: 99%

Association of NPAC score with survival after acute myocardial infarction

et al. 2020

Atherosclerosis

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Background: Risk stratification in acute myocardial infarction (AMI) is important for guiding clinical management. Current risk scores are mostly derived from clinical trials with stringent patient selection. We aimed to establish and evaluate a composite scoring system to improve short-term mortality classification after index episodes of AMI, independent of electrocardiography (ECG) pattern, in a large realworld cohort.Methods: Using electronic health records, patients admitted to our regional teaching hospital (derivation cohort, n=1747) and an independent tertiary care center (validation cohort, n=1276) with index acute myocardial infarction between January 2013 and December 2017 as confirmed by principal diagnosis and laboratory findings, were identified retrospectively.Results: Univariate logistic regression was used as the primary model to identify potential contributors to mortality. Stepwise forward likelihood ratio logistic regression revealed that neutrophil-to-lymphocyte ratio, peripheral vascular disease, age, and serum creatinine (NPAC) were significant for 90-day mortality (Hosmer-Lemeshow test, P=0.21). Each component of the NPAC score was weighted by betacoefficients in multivariate analysis. The C-statistic of the NPAC score was 0.75, which was higher than the conventional Charlson's score (C-statistic=0.63). Judicious application of a deep learning model to our dataset improved the accuracy of classification with a C-statistic of 0.81. Conclusions:The NPAC score comprised of four items from routine laboratory parameters and basic clinical information and can facilitate early identification of cases at risk of short-term mortality following index myocardial infarction. Deep learning model can serve as a gate-keeper to facilitate clinical decision making.

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Section: Introductionmentioning

confidence: 99%

Association of NPAC score with survival after acute myocardial infarction

et al. 2020

Atherosclerosis

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“…Despite well-established guidelines for the management of STEMI, there are still differences with regard to the epidemiology, diagnostics and treatment of patients, leading to diverging morbidity and mortality rates across the globe. Not all reasons for these differences are well understood [6].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Clinical Characteristics and Outcomes in Patients with STEMI in Croatia and Kosovo

Koshi¹,

Maja²,

Miličić³

et al. 2020

J Heart

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INTRODUCTION The aim of our study was to compare clinical characteristics, risk factors, treatment modalities and medium-term outcomes in STEMI patients in two different countries, Croatia and Kosovo. MATERIAL AND METHODS The study included 77 consecutive patients from two regional hospitals, included in the STEMI network of University Clinical Center Zagreb, Croatia (group 1), and 75 STEMI consecutive patients treated in regional Hospital Gjakova, Kosovo (group 2). Standard laboratory tests were performed in both study groups. Patients were treated by the standard protocol of the country and hospital where they were treated. Immediate clinical outcomes and 6 months follow up results regarding MACE were compared. RESULTS There was no significant difference between groups in basic clinical characteristic except for diabetes mellitus, (x2 = 6.96, P = 0.008, P <0.01) and glycaemia control (U’ = 1530, P = 0.013).No significant difference between two groups in laboratory findings. There was a difference in percent of patients treated with primary PCI, 71 in gr 1 and 55 in group 2, reaching statistical significance (x2 test 8,261, p = 0.0045). In patients treated with PCI, there was no difference in “door to balloon time” (DTB) between groups. There was a remarkable difference in proportion of drug eluting stent (DES) implantation (3.5% in group 1, 29.1% in group 2 (x2 test 13.5, P = 0.0002).The difference partly derives from the relatively large number of balloon interventions in group 2. There was 2 deaths in group 1 in early hospital period, both during interventional procedure, one of the patients was in cardiogenic shock. There was no early mortality in group 2. In 6 month clinical follow up there were 3 deaths in group 2, all in patient with no revascularization, and no death in group 1. CONCLUSION We compared the clinical characteristics, treatment strategies and outcomes, in STEMI patients from two countries. After initial mortality, patients from Croatia had a better mid-term survival after recovery from their AMI compared to patients from Kosovo. Use of revascularization procedures was beneficial, but it was less often performed in Kosovo

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“…Cardiac rehabilitation programs after AMI are safe and effective in increasing exercise tolerance, quality of life, and left ventricular ejection fraction, but they require a close cooperation between cardiologists, general practitioners, and rehabilitation physicians. 28,29 An analysis by Kampfer et al 30 performed in 3 tertiary hospitals in Switzerland, Poland, and Ukraine (high-, middle-, and low -income countries, respectively) showed essential differences in the application of evidence -based treatment and secondary prevention after AMI. The total mortality rate was inversely related to the proportions of patients participating in cardiac rehabilitation programs and the socioeconomic status of these countries.…”

Section: Methods Study Designmentioning

confidence: 99%