The mortality rates in registries of patients with STEMI are highly affected by inclusion criteria and population characteristics

Martins, Elie; Magné, Julien; Pradel, Valérie; Faugeras, Gilles; Bosle, Sebastien; Cailloce, Dominique; Darodes, Nicole; Fleurant, E.; Karam, H.; Petitcolin, Pierre Bernard; Pages, Pierre A.; Rousselle, V.; Virot, P; Aboyans, Victor

doi:10.1080/00015385.2020.1848970

Cited by 4 publications

(3 citation statements)

References 24 publications

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“…This finding may be explained by the high median age of female patients (72 years) and the high proportion of patients presenting with Killip class IV or cardiogenic shock (10.8%). Registries with comparable patient characteristics reported similar outcomes [ 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

Implementation of the ESC STEMI guidelines in female and elderly patients over a 20-year period in a large German registry

Riehle

Gothe²,

Ebbinghaus

et al. 2023

Clin Res Cardiol

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Aims We investigated the implementation of new guidelines in ST-segment elevation myocardial infarction (STEMI) patients in a large real-world patient population in the metropolitan area of Berlin (Germany) over a 20-year period. Methods From January 2000 to December 2019, a total of 25 792 patients were admitted with STEMI to one of the 34 member hospitals of the Berlin-Brandenburg Myocardial Infarction Registry (B2HIR) and were stratified for sex and age < 75 and ≥ 75 years. Results The median age of women was 72 years (IQR 61–81) compared to 61 years in men (IQR 51–71). PCI treatment as a standard of care was implemented in men earlier than in women across all age groups. It took two years from the 2017 class IA ESC STEMI guideline recommendation to prefer the radial access route rather than femoral until > 60% of patients were treated accordingly. In 2019, less than 60% of elderly women were treated via a radial access. While the majority of patients < 75 years already received ticagrelor or prasugrel as antiplatelet agent in the year of the class IA ESC STEMI guideline recommendation in 2012, men ≥ 75 years lagged two years and women ≥ 75 three years behind. Amongst the elderly, in-hospital mortality was 22.6% (737) for women and 17.3% (523) for men (p < 0.001). In patients < 75 years fatal outcome was less likely with 7.2% (305) in women and 5.8% (833) in men (p < 0.001). After adjustment for confounding variables, female sex was an independent predictor of in-hospital mortality in patients ≥ 75 years (OR 1.37, 95% CI 1.12–1.68, p = 0.002), but not in patients < 75 years (p = 0.076). Conclusion In-hospital mortality differs considerably by age and sex and remains highest in elderly patients and in particular in elderly females. In these patient groups, guideline recommended therapies were implemented with a significant delay. Graphical abstract

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Section: Discussionmentioning

confidence: 99%

Implementation of the ESC STEMI guidelines in female and elderly patients over a 20-year period in a large German registry

Riehle

Gothe²,

Ebbinghaus

et al. 2023

Clin Res Cardiol

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“…Myocardial infarction with ST-wave dysgenesis is a very severe condition, and mortality in this disease is in uenced by a large number of patient characteristics. For example, female gender, aging, anterior myocardial infarction, and prior coronary artery disease are associated with worse outcomes in these patients [13].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Cardiac Risk Factors Among ST-Elevation Myocardial Infarction (STEMI) Patients at Damascus Hospital

Kadoura

Muhammed

Shamia

2022

Preprint

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Introduction: ST-segment elevation myocardial infarction (STEMI) emergency care networks aim to reduce ischemic times. The influence of risk factors such as sex, age, social habits on prognosis is still being debated. Over half of (STEMI) cases occur in adults < 65 years old, with approximately 10% of all STEMIs affecting individuals < 45 years of age. Therefore, this study aims to assess the prevalence of myocardial risk factors on STEMI patients at Damascus hospital. Methods A retrospective study was conducted during the years 2020–2022. All patients with STEMI admitted to cardiovascular department of Damascus hospital were included. Chi-square analysis was used to compare Infarction type and age categories with sociodemographic factors and patients’ medical history variables. One-way analysis of variance (ANOVA) and t-test were used to compare means of continuous variables (Age, smoking period). Results of 150 patients, 123 (82%) were males, and 27 (18%) were females. Most of patients aged between 51 and 60 years respectively. 105 (70%) of the patients were smokers, 37 (67.3%) had diabetes, and 47 (31.3%) had hypertension. Most of STEMI patients aged 41–50 years were significantly associated with male sex. The majority of patients aged 30–40 were significantly associated with smokers (p < 0.05). Conclusion These findings indicate a high burden of risk factors in younger adults with STEMI. Programs to target sociodemographic factors including smoking, obesity, and comorbid diseases, are necessary to more effectively address health disparities in STEMI and its adverse consequences.

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“…However, most of the previous studies were not confined to patients who received newer-generation DES [7,8,22,25] and patients who were current smokers. [7,8,[23][24][25][33][34][35] Martins et al [36] suggested that different mortality rates in the registry data are partly due to differences in inclusion criteria and demographic data. In our study, to reflect current trends of PCI, all STEMI and NSTEMI patients were confined to individuals who received newer-generation DESs and who were current smokers.…”

Section: Discussionmentioning

confidence: 99%

ST-segment elevation versus non-ST-segment elevation myocardial infarction in current smokers after newer-generation drug-eluting stent implantation

et al. 2021

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We compared the 2-year major clinical outcomes between ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) in patients who are current smokers who underwent successful percutaneous coronary intervention (PCI) with newer-generation drug-eluting stents (DESs). The availability of data in this regard is limited. A total of 8357 AMI patients were included and divided into 2 groups: the STEMI group (n = 5124) and NSTEMI group (n = 3233). The primary endpoint was the occurrence of major adverse cardiac events (MACE), defined as all-cause death, recurrent myocardial infarction (re-MI), or coronary repeat revascularization. The secondary endpoints were the cumulative incidences of the individual components of MACE and stent thrombosis (definite or probable). After propensity score-matched (PSM) analysis, 2 PSM groups (2250 pairs, C-statistics = 0.795) were generated. In the PSM patients, both for 1 month and at 2 years, the cumulative incidence of MACE ( P = .183 and P = .655, respectively), all-cause death, cardiac death, re-MI, all-cause death or MI, any repeat revascularization, and stent thrombosis ( P = .998 and P = .341, respectively) was not significantly different between the STEMI and NSTEMI groups. In addition, these results were confirmed using multivariate analysis. In the era of contemporary newer-generation DESs, both during 1 month and at 2 years after index PCI, the major clinical outcomes were not significantly different between the STEMI and NSTEMI groups confined to the patients who are current smokers. However, further research is needed to confirm these results.

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The mortality rates in registries of patients with STEMI are highly affected by inclusion criteria and population characteristics

Cited by 4 publications

References 24 publications

Implementation of the ESC STEMI guidelines in female and elderly patients over a 20-year period in a large German registry

Implementation of the ESC STEMI guidelines in female and elderly patients over a 20-year period in a large German registry

Prevalence of Cardiac Risk Factors Among ST-Elevation Myocardial Infarction (STEMI) Patients at Damascus Hospital

ST-segment elevation versus non-ST-segment elevation myocardial infarction in current smokers after newer-generation drug-eluting stent implantation

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