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Statistics on mortality following acute myocardial infarction in 842,897 Europeans.

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journal contribution
posted on 30.07.2019, 13:59 by OA Alabas, T Jernberg, M Pujades-Rodriguez, MJ Rutherford, RM West, M Hall, A Timmis, B Lindahl, KAA Fox, H Hemingway, CP Gale
AIMS: To compare ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) mortality between Sweden and the UK, adjusting for background population rates of expected death, case mix and treatments. METHODS AND RESULTS: National data were collected from hospitals in Sweden (n = 73 hospitals, 180,368 patients, Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies [SWEDEHEART]) and the UK (n = 247, 662,529 patients, Myocardial Ischaemia National Audit Project [MINAP]) between 2003 and 2013. There were lower rates of revascularisation [STEMI (43.8% vs. 74.9%); NSTEMI (27.5% vs 43.6%)] and pharmacotherapies at time of hospital discharge including [aspirin (82.9% vs. 90.2%) and (79.9% vs. 88.0%), β-blockers (73.4% vs. 86.4%) and (65.3% vs. 85.1%)] in the UK compared with Sweden, respectively. Standardised net probability of death (NPD) between admission and 1 month was higher in the UK for STEMI (8.0 [95% confidence interval 7.4-8.5] vs. 6.7 [6.5-6.9]) and NSTEMI (6.8 [6.4-7.2] vs. 4.9 [4.7-5.0]). Between 6 months and 1 year and more than 1 year, NPD remained higher in the UK for NSTEMI (2.9 [2.5-3.3] vs. 2.3 [2.2-2.5]) and (21.4 [20.0-22.8] vs. 18.3 [17.6-19.0]), but was similar for STEMI (0.7 [0.4-1.0] vs. 0.9 [0.7-1.0]) and (8.4 [6.7-10.1] vs. 8.3 [7.5-9.1]). CONCLUSION: Short-term mortality following STEMI and NSTEMI was higher in the UK compared with Sweden. Mid- and longer-term mortality remained higher in the UK for NSTEMI, but was similar for STEMI.Differences in mortality may be due to differential use of guideline-indicated treatments.

Funding

This work was supported by grants from the Swedish Heart and Lung Foundation and the regional agreement on medical training and clinical research (ALF) between Stockholm County Council and Karolinska Institute. The Myocardial Ischaemia National Audit Project (MINAP) is commissioned by the Health Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP).

History

Citation

Cardiovascular Research, 2019, cvz197

Author affiliation

/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Health Sciences

Version

AM (Accepted Manuscript)

Published in

Cardiovascular Research

Publisher

Oxford University Press (OUP) for European Society of Cardiology

eissn

1755-3245

Acceptance date

18/07/2019

Copyright date

2019

Publisher version

https://academic.oup.com/cardiovascres/advance-article/doi/10.1093/cvr/cvz197/5539698

Notes

The file associated with this record is under embargo until 12 months after publication, in accordance with the publisher's self-archiving policy. The full text may be available through the publisher links provided above.

Language

en

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