Xavier Rosselló1, Yong Huo2, Stuart Pocock1, Frans Van de Werf3, Chee Tang Chin4, Nicolas Danchin5, Stephen W-L Lee6, Jesús Medina7, Ana Vega7, Héctor Bueno8. 1. London School of Hygiene and Tropical Medicine, London, UK. 2. Department of Cardiology, Peking University First Hospital, Beijing, China. 3. University Hospitals Leuven, Belgium. 4. National Heart Centre Singapore, Singapore. 5. Hôpital Européen Georges Pompidou & René Descartes University, Paris, France. 6. Queen Mary Hospital, Hong Kong SAR, China. 7. Medical Evidence and Observational Research, Global Medical Affairs, AstraZeneca, Madrid, Spain. 8. Centro Nacional de Investigaciones Cardiovasculares (CNIC), Spain; Instituto de investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre, Spain; Universidad Complutense de Madrid, Spain. Electronic address: hbueno@cnic.es.
Abstract
BACKGROUND: There is a shortage of information on regional variations in ST-segment elevation myocardial infarction (STEMI) management and prognosis at a global level. We aimed to compare patient profiles, in-hospital management and post-discharge mortality across several world regions. METHODS: In total, 11,559 patients with STEMI were enrolled in two prospective studies of acute coronary syndrome survivors: EPICOR (4943 patients from 555 hospitals in 20 countries in Europe and Latin America recruited between September 2010 and March 2011) and EPICOR Asia (6616 patients from 218 hospitals in eight Asian countries recruited between June 2011 and May 2012). Comparisons were performed by eight pre-defined regions: Northern Europe (NE), Southern Europe (SE), Eastern Europe (EE), Latin America (LA), China (CN), India (IN), Southeast Asia (SA), and South Korea/Hong Kong/Singapore (KS). RESULTS: Reperfusion therapy rates ranged between 53.9% (IN) and 81.2% (SE), primary percutaneous coronary intervention (PCI) between 24.8% (IN) and 65.6% (NE) and fibrinolysis between 8.1% (CN) and 34.2% (SA). Median time to primary PCI (h) ranged from 3.9 (NE) to 20.9 (IN) and to fibrinolysis from 2.4 (SE) to 6.3 (IN). Two-year mortality ranged between 2.5% in NE and 7.4% in LA. Regional variations in mortality persisted after adjustment for reperfusion therapy and known prognostic factors. CONCLUSIONS: Among patients with STEMI, there is a wide regional variation in clinical profiles, hospital care and mortality. Substantial room for improvement remains at a global level for increasing reperfusion rates, reducing delays and post-discharge mortality in patients with STEMI.
BACKGROUND: There is a shortage of information on regional variations in ST-segment elevation myocardial infarction (STEMI) management and prognosis at a global level. We aimed to compare patient profiles, in-hospital management and post-discharge mortality across several world regions. METHODS: In total, 11,559 patients with STEMI were enrolled in two prospective studies of acute coronary syndrome survivors: EPICOR (4943 patients from 555 hospitals in 20 countries in Europe and Latin America recruited between September 2010 and March 2011) and EPICOR Asia (6616 patients from 218 hospitals in eight Asian countries recruited between June 2011 and May 2012). Comparisons were performed by eight pre-defined regions: Northern Europe (NE), Southern Europe (SE), Eastern Europe (EE), Latin America (LA), China (CN), India (IN), Southeast Asia (SA), and South Korea/Hong Kong/Singapore (KS). RESULTS: Reperfusion therapy rates ranged between 53.9% (IN) and 81.2% (SE), primary percutaneous coronary intervention (PCI) between 24.8% (IN) and 65.6% (NE) and fibrinolysis between 8.1% (CN) and 34.2% (SA). Median time to primary PCI (h) ranged from 3.9 (NE) to 20.9 (IN) and to fibrinolysis from 2.4 (SE) to 6.3 (IN). Two-year mortality ranged between 2.5% in NE and 7.4% in LA. Regional variations in mortality persisted after adjustment for reperfusion therapy and known prognostic factors. CONCLUSIONS: Among patients with STEMI, there is a wide regional variation in clinical profiles, hospital care and mortality. Substantial room for improvement remains at a global level for increasing reperfusion rates, reducing delays and post-discharge mortality in patients with STEMI.
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Authors: Yong Huo; Frans Van de Werf; Yaling Han; Xavier Rossello; Stuart J Pocock; Chee Tang Chin; Stephen W-L Lee; Yi Li; Jie Jiang; Ana Maria Vega; Jesús Medina; Héctor Bueno Journal: Am J Cardiovasc Drugs Date: 2021-02-04 Impact factor: 3.571