Bashar Hussein, Matetić Andrija, Curzen Nick, Mamas Mamas A
Faculty of Medicine, University of Southampton, United Kingdom; Coronary Research Group, University Hospital Southampton NHS Foundation Trust, United Kingdom; Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, United Kingdom.
Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, United Kingdom; Department of Cardiology, University Hospital of Split, Split, Croatia.
Cardiovasc Revasc Med. 2023 Jan;46:3-9. doi: 10.1016/j.carrev.2022.08.023. Epub 2022 Aug 24.
The variation in the management and outcome of acute myocardial infarction (AMI) between rural and urban settings has been previously recognized, but there has previously been no nationwide data reported that is inclusive of the whole adult population.
All discharge records between 2004 and 2018 with AMI diagnosis were extracted from the National Inpatient Sample (NIS) database and stratified by hospital location. The primary outcome was in-hospital mortality, and secondary outcomes included (a) major adverse cardiovascular and cerebrovascular events (MACCE), (b) major bleeding, (c) acute ischemic stroke, the utilization of invasive management in the form of (d) coronary angiography (CA), and (e) percutaneous coronary intervention (PCI). The adjusted odds ratios (aOR) and 95 % confidence interval (95 % CI) were determined using multivariable logistic regression.
9,728,878 records with AMI were identified, of which 1,011,637 (10.4 %) discharges were from rural hospitals. Rural patients were older (median of 71 years vs. 67 years, p < 0.001) and had lower prevalence of the highest risk presentations of AMI than their urban counterparts. After multivariable adjustment, patients from rural hospitals had increased aOR of all-cause mortality (aOR 1.15 95 % CI 1.13-1.16) and MACCE (aOR 1.04 95 % CI 1.04-1.05), as well as the decreased aOR of coronary angiography (aOR 0.29, 95 % CI 0.29-0.29, p < 0.001) and PCI (aOR 0.40, 95 % CI 0.39-0.40, p < 0.001), compared to their urban counterparts.
Between 2004 and 2018, the risk of in-hospital mortality and MACCE in AMI patients was significantly higher in rural hospitals, with considerably lower utilization of invasive angiography and revascularization.
此前已认识到农村和城市地区急性心肌梗死（AMI）管理及结局存在差异，但此前尚无涵盖全体成年人口的全国性数据报告。
从国家住院患者样本（NIS）数据库中提取2004年至2018年期间所有诊断为AMI的出院记录，并按医院位置分层。主要结局是住院死亡率，次要结局包括：（a）主要不良心血管和脑血管事件（MACCE），（b）大出血，（c）急性缺血性卒中，以（d）冠状动脉造影（CA）和（e）经皮冠状动脉介入治疗（PCI）形式的侵入性治疗的使用情况。使用多变量逻辑回归确定调整后的优势比（aOR）和95%置信区间（95%CI）。
共识别出9,728,878条AMI记录，其中1,011,637例（10.4%）出院记录来自农村医院。农村患者年龄更大（中位数71岁对67岁，p<0.001），与城市患者相比，AMI最高风险表现的患病率更低。多变量调整后，与城市医院的患者相比，农村医院的患者全因死亡率（aOR 1.15，95%CI 1.13 - 1.16）和MACCE（aOR 1.04，95%CI 1.04 - 1.05）的aOR增加，冠状动脉造影（aOR 0.29，95%CI 0.29 - 0.29，p<0.001）和PCI（aOR 0.40，95%CI 0.39 - 0.40，p<0.001）的aOR降低。
在2004年至2018年期间，农村医院AMI患者的住院死亡率和MACCE风险显著更高，侵入性血管造影和血运重建的使用率则低得多。
