CHU Limoges, Hôpital Dupuytren, Limoges, France.
INSERM 1094, Faculté de médecine de Limoges Service de Cardiologie, Limoges, France.
Acta Cardiol. 2021 Jul;76(5):504-512. doi: 10.1080/00015385.2020.1848970. Epub 2021 Jan 22.
Different mortality rates are reported in registries of patients with ST-segment elevation myocardial infarction (STEMI), but comparisons between registries are challenging.
To determine whether the higher mortality rate in our regional French registry (SCALIM) is related to different inclusion criteria and demographic characteristics.
The SCALIM registry included all patients with STEMI within the first 24 h in the region of Limousin, France (06/2011-01/2015). To compare mortality rates with other contemporary registries in France and European neighbouring countries, the others' inclusion criteria were applied to the SCALIM registry.
Among 1501 patients included, in-hospital and 1-month mortality were 8.2% and 8.8% respectively, significantly higher than many other registries. The use of inclusion criteria from EMUST (France), MINAP (UK) or LOMBARDIMA (Italy) markedly decreased the number of enrolled patients by 64%, 36%, and 21%, respectively. When those inclusion criteria were applied to the SCALIM registry, difference in in-hospital and 1-month mortality rates between other registries and ours remained significant. In the multivariate analysis, age, initial acute pulmonary oedema (Killip class ≥2), complication occurring before percutaneous coronary intervention, absence of transfer to an interventional cardiology centre for primary angioplasty and lack of reperfusion therapy within 12 h were associated with higher risk of 1-month mortality (all < 0.05). Age (65 versus 63.3 years, < 0.001) was higher and reperfusion rate (84.2 versus 74.7%, < 0.001) was significantly lower in SCALIM than FAST-MI, the national French registry on STEMI patients. Interestingly, the 3% of patients included in SCALIM who would be excluded from FAST-MI registry had 91% mortality at one month.
Higher mortality rate in our regional SCALIM registry is in part due to differences in inclusion criteria and demographic data. Consensus should be made to harmonise inclusion criteria in STEMI registries for the sake of comparability.
ST 段抬高型心肌梗死（STEMI）患者的登记报告死亡率不同，但登记之间的比较具有挑战性。
确定我们的法国地区登记处（SCALIM）较高的死亡率是否与不同的纳入标准和人口统计学特征有关。
SCALIM 登记处纳入了法国利穆赞地区在 24 小时内首次发生 STEMI 的所有患者（2011 年 6 月至 2015 年 1 月）。为了与法国和欧洲邻国的其他当代登记处的死亡率进行比较，将其他登记处的纳入标准应用于 SCALIM 登记处。
在纳入的 1501 例患者中，住院期间和 1 个月的死亡率分别为 8.2%和 8.8%，明显高于许多其他登记处。应用 EMUST（法国）、MINAP（英国）或 LOMBARDIMA（意大利）的纳入标准，分别使纳入患者数量减少了 64%、36%和 21%。当将这些纳入标准应用于 SCALIM 登记处时，其他登记处和我们的登记处之间的住院和 1 个月死亡率差异仍然显著。在多变量分析中，年龄、初始急性肺水肿（Killip 分级≥2）、经皮冠状动脉介入治疗前发生的并发症、未转至介入心脏病学中心进行直接经皮冠状动脉介入治疗以及 12 小时内未进行再灌注治疗与 1 个月死亡率升高相关（均 < 0.05）。年龄（65 岁与 63.3 岁， < 0.001）较高，再灌注率（84.2%与 74.7%， < 0.001）较低，这是在 SCALIM 与 FAST-MI（法国国家 STEMI 患者登记处）之间的差异。有趣的是，在 SCALIM 登记处纳入的可能会被 FAST-MI 排除的 3%患者，1 个月死亡率为 91%。
我们地区的 SCALIM 登记处的较高死亡率部分归因于纳入标准和人口统计学数据的差异。为了提高可比性，应该就 STEMI 登记处的纳入标准达成共识。
