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Associations of changes in patient characteristics and management with decrease in mortality rates of men and women with ST-elevation myocardial infarction - a propensity score-matched analysis.
Archives of Medical Science ( IF 3.8 ) Pub Date : 2020-03-10 , DOI: 10.5114/aoms.2020.93458 Lukasz Zandecki 1, 2 , Marianna Janion 1, 2 , Marcin Sadowski 2, 3 , Jacek Kurzawski 1 , Lech Polonski 4 , Marek Gierlotka 4 , Mariusz Gasior 4
Archives of Medical Science ( IF 3.8 ) Pub Date : 2020-03-10 , DOI: 10.5114/aoms.2020.93458 Lukasz Zandecki 1, 2 , Marianna Janion 1, 2 , Marcin Sadowski 2, 3 , Jacek Kurzawski 1 , Lech Polonski 4 , Marek Gierlotka 4 , Mariusz Gasior 4
Affiliation
INTRODUCTION
The aim of this study is to estimate how much of the recent decrease in mortality among patients with myocardial infarction with ST-segment elevation (STEMI) can be attributed to improved treatment strategies, and how much it is related to changes in baseline clinical characteristics, and to compare these findings for men and women.
MATERIAL AND METHODS
This was a retrospective analysis of 32,790 patients with STEMI from the Polish Registry of Acute Coronary Syndromes PL-ACS hospitalised in 2005 and 2011. Changes in treatment strategies including pharmacotherapy were analysed. Observed in-hospital and 12-month mortality rates were compared with the outcomes in the groups matched on the propensity scores.
RESULTS
There was a substantial improvement in STEMI patient management between 2005 and 2011 in Poland. It included greater use of percutaneous coronary interventions and other guideline-based adjunctive therapies, and it was associated with a significant decline in in-hospital mortality. Relative 12-month mortality reduction rates were less pronounced and more related to changes in patients' clinical characteristics. Higher mortality risk reductions were observed in women and were driven by relatively more positive changes in their baseline risk profiles when compared to men.
CONCLUSIONS
The progress in the treatment strategies has helped to achieve better survival rates in STEMI patients. However, the ongoing changes in clinical characteristics of patients also played an important role, especially in women. Clinicians should focus on modifiable risk factors and post-discharge management to possibly prolong the positive aspects of in-hospital efforts.
中文翻译:
患者特征和管理的变化与 ST 段抬高型心肌梗死男性和女性死亡率降低的关联——倾向评分匹配分析。
引言 本研究的目的是估计近期 ST 段抬高型心肌梗死 (STEMI) 患者死亡率的降低在多大程度上可归因于治疗策略的改进,以及与基线临床特征的变化有多大关系,并比较男性和女性的这些发现。材料和方法 这是对 2005 年和 2011 年波兰急性冠状动脉综合征登记处 PL-ACS 住院的 32,790 名 STEMI 患者的回顾性分析。分析了包括药物治疗在内的治疗策略的变化。将观察到的住院和 12 个月死亡率与倾向评分匹配的组中的结果进行比较。结果 2005 年至 2011 年间,波兰的 STEMI 患者管理有了显着改善。它包括更多地使用经皮冠状动脉介入治疗和其他基于指南的辅助疗法,并且与住院死亡率显着下降有关。相对 12 个月死亡率降低率不太明显,与患者临床特征的变化更相关。在女性中观察到更高的死亡风险降低,并且与男性相比,其基线风险状况发生了相对更积极的变化。结论 治疗策略的进步有助于提高 STEMI 患者的生存率。然而,患者临床特征的持续变化也发挥了重要作用,尤其是在女性中。
更新日期:2020-03-10
中文翻译:
患者特征和管理的变化与 ST 段抬高型心肌梗死男性和女性死亡率降低的关联——倾向评分匹配分析。
引言 本研究的目的是估计近期 ST 段抬高型心肌梗死 (STEMI) 患者死亡率的降低在多大程度上可归因于治疗策略的改进,以及与基线临床特征的变化有多大关系,并比较男性和女性的这些发现。材料和方法 这是对 2005 年和 2011 年波兰急性冠状动脉综合征登记处 PL-ACS 住院的 32,790 名 STEMI 患者的回顾性分析。分析了包括药物治疗在内的治疗策略的变化。将观察到的住院和 12 个月死亡率与倾向评分匹配的组中的结果进行比较。结果 2005 年至 2011 年间,波兰的 STEMI 患者管理有了显着改善。它包括更多地使用经皮冠状动脉介入治疗和其他基于指南的辅助疗法,并且与住院死亡率显着下降有关。相对 12 个月死亡率降低率不太明显,与患者临床特征的变化更相关。在女性中观察到更高的死亡风险降低,并且与男性相比,其基线风险状况发生了相对更积极的变化。结论 治疗策略的进步有助于提高 STEMI 患者的生存率。然而,患者临床特征的持续变化也发挥了重要作用,尤其是在女性中。