Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernandez Almagro, 3, 28029, Madrid, Spain.
Instituto de investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.
Clin Res Cardiol. 2018 Sep;107(9):836-844. doi: 10.1007/s00392-018-1254-y. Epub 2018 Apr 16.
Therapeutic variability not explained by patient clinical characteristics is a potential source of avoidable morbidity and mortality. We aimed to explore regional variability in the management and mortality of patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS).
11,931 NSTE-ACS hospital survivors enrolled in two prospective registries: EPICOR [5625 patients, 555 hospitals, 20 countries in Europe (E) and Latin America (LA), September 2010-March 2011] and EPICOR Asia (6306 patients, 218 hospitals, 8 countries, June 2011-May 2012) were compared among eight pre-defined regions: Northern E (NE), Southern E (SE), Eastern E (EE); Latin America (LA); China (CN), India (IN), South-East Asia (SA), and South Korea, Hong Kong and Singapore (KS). Patient characteristics differed between regions: mean age (lowest 59 years, IN; highest 65.9 years, SE), diabetes (21.4% NE; 35.5% IN) and smoking (32% NE; 62% IN). Variations in dual antiplatelet therapy at discharge (lowest 83.1%, IN; highest 97.5%, SA), coronary angiography (53.9% SA; 90.6% KS), percutaneous coronary intervention (35.8% SA; 78.6% KS) and coronary artery bypass graft (0.7% KS; 5.7% NE) were observed. Unadjusted 2-year mortality ranged between 3.8% in KS and 11.7% in SE. Two-year, risk-adjusted mortality rates ranged between 5.1% (95% confidence interval 2.9-7.3%) in KS to 10.5% (8.3-12.7%) in LA.
Wide regional variations in patient features, hospital care, coronary revascularization and post-discharge mortality are present among patients hospitalized for NSTE-ACS. Focused regional interventions to improve the quality of care for NSTE-ACS patients are still needed.
无法用患者临床特征解释的治疗变异性是可避免发病率和死亡率的潜在来源。我们旨在探讨非 ST 段抬高型急性冠脉综合征（NSTE-ACS）患者管理和死亡率的区域性差异。
两项前瞻性注册研究（EPICOR[5625 例患者，555 家医院，20 个欧洲（E）和拉丁美洲（LA）国家，2010 年 9 月至 2011 年 3 月]和 EPICOR Asia[6306 例患者，218 家医院，8 个国家，2011 年 6 月至 2012 年 5 月]）中纳入了 11931 例 NSTE-ACS 住院幸存者，将其与 8 个预先确定的地区进行比较：北欧（NE）、南欧（SE）、东欧（EE）；拉丁美洲（LA）；中国（CN）、印度（IN）、东南亚（SA）和韩国、香港和新加坡（KS）。地区间患者特征存在差异：平均年龄（最低 59 岁，IN；最高 65.9 岁，SE）、糖尿病（21.4%NE；35.5%IN）和吸烟（32%NE；62%IN）。出院时双联抗血小板治疗（最低 83.1%，IN；最高 97.5%，SA）、冠状动脉造影（53.9%SA；90.6%KS）、经皮冠状动脉介入治疗（35.8%SA；78.6%KS）和冠状动脉旁路移植术（0.7%KS；5.7%NE）的差异。未调整的 2 年死亡率在 KS 为 3.8%，在 SE 为 11.7%。2 年风险调整死亡率在 KS 为 5.1%（95%置信区间 2.9-7.3%），在 LA 为 10.5%（8.3-12.7%）。
NSTE-ACS 住院患者的患者特征、医院护理、冠状动脉血运重建和出院后死亡率存在广泛的区域性差异。仍然需要针对 NSTE-ACS 患者进行有针对性的区域性干预，以改善护理质量。
