Salzwedel Annett, Völler Heinz, Reibis Robert, Bonaventura Klaus, Behrens Steffen, Reibis Rona
Professur für Rehabilitationswissenschaften, Universität Potsdam.
Ernst von Bergmann Klinikum, Klinik für Kardiologie und Angiologie, Potsdam.
Dtsch Med Wochenschr. 2018 Apr;143(8):e51-e58. doi: 10.1055/s-0043-123907. Epub 2018 Jan 9.
In recent decades, guideline-based therapy of myocardial infarction has led to a considerable reduction in myocardial infarction mortality. However, there are relevant differences in acute care and the extent of infarction mortality. The objective of this survey was to analyze the current care situation of patients with acute myocardial infarction in the region of northeast Germany (Berlin, Brandenburg and Mecklenburg-Vorpommern).
Based on pseudonymized data from a statutory health insurance of 1 387 084 persons, a total of 6733 patients with inpatient admission at MI were filtered using the ICD10 code I21 and I22 for 2012. Total inhospital mortality and 1-year mortality and prognostic parameters were evaluated and analyzed in country comparisons.
Both the hospital mortality rate and the 1-year mortality rate of the individual countries (Berlin 13.6 resp. 27.5 %, respectively, BRB 13.9 and 27.9 %, MV 14.4 and 29.0 %, respectively) were comparable to the overall rate (13.9 % or 28.0 %) and in the country comparison. In the multiple analysis, the 1-year mortality was determined by the invasive strategy (OR 0.42, 95 % CI 0.35 - 0.51, p < 0.001) as well as by the implementation of the guidelines-based secondary prevention (OR 0.14, 95 % CI 0.12 - 0.17, p < 0.001). There were no statistical differences between the three federal states.
The investigated population of patients with acute MI in Berlin, Brandenburg and Mecklenburg-Vorpommern demonstrated a comparable inpatient and post-hospital care and 1-year prognosis regardless of the federal state assignment. Referral to coronary angiography and adequate implementation of evidence-based medication demonstrated a significant prognostic impact.
近几十年来，基于指南的心肌梗死治疗使心肌梗死死亡率大幅降低。然而，在急性护理和梗死死亡率程度方面存在相关差异。本次调查的目的是分析德国东北部地区（柏林、勃兰登堡和梅克伦堡 - 前波美拉尼亚）急性心肌梗死患者的当前护理情况。
基于来自1387084人的法定健康保险的化名数据，使用2012年的ICD10编码I21和I22筛选出总共6733例因心肌梗死住院的患者。在国家比较中评估和分析了总住院死亡率、1年死亡率和预后参数。
各个国家（柏林分别为13.6%和27.5%，勃兰登堡为13.9%和27.9%，梅克伦堡 - 前波美拉尼亚分别为14.4%和29.0%）的医院死亡率和1年死亡率与总体率（13.9%或28.0%）以及在国家比较中相当。在多因素分析中，1年死亡率由侵入性策略（比值比0.42，95%置信区间0.35 - 0.51，p < 0.001）以及基于指南的二级预防的实施情况（比值比0.14，95%置信区间0.12 - 0.17，p < 0.001）决定。三个联邦州之间没有统计学差异。
在柏林、勃兰登堡和梅克伦堡 - 前波美拉尼亚调查的急性心肌梗死患者群体，无论联邦州归属如何，都表现出相当的住院和院后护理情况以及1年预后。转诊进行冠状动脉造影和充分实施循证药物治疗显示出显著的预后影响。
