BackgroundWe evaluated whether a comprehensive ST‐segment–elevation myocardial infarction protocol (CSP) focusing on guideline‐directed medical therapy, transradial percutaneous coronary intervention, and rapid door‐to‐balloon time improves process and outcome metrics in patients with moderate or high socioeconomic deprivation.Methods and ResultsA total of 1761 patients with ST‐segment–elevation myocardial infarction treated with percutaneous coronary intervention at a single hospital before (January 1, 2011–July 14, 2014) and after (July 15, 2014– July 15, 2019) CSP implementation were included in an observational cohort study. Neighborhood deprivation was assessed by the Area Deprivation Index and was categorized as low (≤50th percentile; 29.0%), moderate (51st –90th percentile; 40.8%), and high (>90th percentile; 30.2%). The primary process outcome was door‐to‐balloon time. Achievement of guideline‐recommend door‐to‐balloon time goals improved in all deprivation groups after CSP implementation (low, 67.8% before CSP versus 88.5% after CSP; moderate, 50.7% before CSP versus 77.6% after CSP; high, 65.5% before CSP versus 85.6% after CSP; all P<0.001). Median door‐to‐balloon time among emergency department/in‐hospital patients was significantly noninferior in higher versus lower deprivation groups after CSP (noninferiority limit=5 minutes; P_{noninferiority} high versus moderate = 0.002, high versus low <0.001, moderate versus low = 0.02). In‐hospital mortality, the primary clinical outcome, was significantly lower after CSP in patients with moderate/high deprivation in unadjusted (before CSP 7.0% versus after CSP 3.1%; odds ratio [OR], 0.42 [95% CI, 0.25–0.72]; P=0.002) and risk‐adjusted (OR, 0.42 [95% CI, 0.23–0.77]; P=0.005) models.ConclusionsA CSP was associated with improved ST‐segment–elevation myocardial infarction care across all deprivation groups and reduced mortality in those from moderate or high deprivation neighborhoods. Standardized initiatives to reduce care variability may mitigate social determinants of health in time‐sensitive conditions such as ST‐segment–elevation myocardial infarction.

中文翻译：

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邻里剥夺与综合 ST 段抬高心肌梗死方案结果的关系

背景我们评估了以指南为导向的药物治疗、经桡动脉经皮冠状动脉介入治疗和快速门到球囊时间的综合 ST 段抬高心肌梗死方案 (CSP) 是否可以改善中度或高度社会经济剥夺患者的过程和结果指标. 方法与结果 2011年1月1日-2014年7月14日前后（2014年7月15日-2019年7月15日）单院经皮冠状动脉介入治疗ST段抬高型心肌梗死患者1761例CSP 实施包括在一项观察性队列研究中。社区剥夺由地区剥夺指数评估，分为低（≤50%；29.0%）、中（51-90%；40.8%）和高（>90%；30.2%）。主要过程结果是门到气球时间。在 CSP 实施后，所有剥夺组的指南推荐的门到气球时间目标的实现都有所改善（低，CSP 前为 67.8%，CSP 后为 88.5%；中等，CSP 前为 50.7%，CSP 后为 77.6%；高，CSP 前为 65.5%） CSP 与 CSP 后的 85.6%；所有P <0.001)。急诊科/住院患者在 CSP 后较高和较低剥夺组的中位门到球囊时间显着非劣效性（非劣效性限制 = 5 分钟；P_非劣效性高与中 = 0.002，高与低 <0.001，中与低= 0.02)。未经调整的中度/高度剥夺患者在 CSP 后住院死亡率（主要临床结果）显着降低（CSP 前 7.0% 与 CSP 后 3.1%；优势比 [OR]，0.42 [95% CI，0.25-0.72 ]；P = 0.002）和风险调整（OR，0.42 [95% CI，0.23–0.77]；P= 0.005) 模型。结论 CSP 与改善所有剥夺组的 ST 段抬高心肌梗死护理和降低中度或高度剥夺社区的死亡率有关。减少护理变异性的标准化举措可能会在时间敏感的情况下（例如 ST 段抬高心肌梗塞）减轻健康的社会决定因素。