根据世界银行国家收入分类，非 ST 段抬高型心肌梗死（NSTEMI）患者的临床表现、治疗和结局：欧洲心脏病学会的 ACVC-EAPCI EORP NSTEMI 注册研究。

Presentation, care, and outcomes of patients with NSTEMI according to World Bank country income classification: the ACVC-EAPCI EORP NSTEMI Registry of the European Society of Cardiology.

机构信息

Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 3AA, Leeds, UK.

Leeds Institute of Data Analytics, University of Leeds, LS2 9NL, Leeds, UK.

出版信息

Eur Heart J Qual Care Clin Outcomes. 2023 Sep 12;9(6):552-563. doi: 10.1093/ehjqcco/qcad008.

BACKGROUND

The majority of NSTEMI burden resides outside high-income countries (HICs). We describe presentation, care, and outcomes of NSTEMI by country income classification.

METHODS AND RESULTS

Prospective cohort study including 2947 patients with NSTEMI from 287 centres in 59 countries, stratified by World Bank country income classification. Quality of care was evaluated based on 12 guideline-recommended care interventions. The all-or-none scoring composite performance measure was used to define receipt of optimal care. Outcomes included in-hospital acute heart failure, stroke/transient ischaemic attack, and death, and 30-day mortality. Patients admitted with NSTEMI in low to lower-middle-income countries (LLMICs), compared with patients in HICs, were younger, more commonly diabetic, and current smokers, but with a lower burden of other comorbidities, and 76.7% met very high risk criteria for an immediate invasive strategy. Invasive coronary angiography use increased with ascending income classification (LLMICs, 79.2%; upper middle income countries [UMICs], 83.7%; HICs, 91.0%), but overall care quality did not (≥80% of eligible interventions achieved: LLMICS, 64.8%; UMICs 69.6%; HICs 55.1%). Rates of acute heart failure (LLMICS, 21.3%; UMICs, 12.1%; HICs, 6.8%; P < 0.001), stroke/transient ischaemic attack (LLMICS: 2.5%; UMICs: 1.5%; HICs: 0.9%; P = 0.04), in-hospital mortality (LLMICS, 3.6%; UMICs: 2.8%; HICs: 1.0%; P < 0.001) and 30-day mortality (LLMICs, 4.9%; UMICs, 3.9%; HICs, 1.5%; P < 0.001) exhibited an inverse economic gradient.

CONCLUSION

Patients with NSTEMI in LLMICs present with fewer comorbidities but a more advanced stage of acute disease, and have worse outcomes compared with HICs. A cardiovascular health narrative is needed to address this inequity across economic boundaries.

背景

大多数非 ST 段抬高型心肌梗死（NSTEMI）的负担存在于高收入国家（HICs）之外。我们按世界银行的国家收入分类描述 NSTEMI 的发病情况、治疗和结果。

方法和结果

前瞻性队列研究纳入了来自 59 个国家 287 个中心的 2947 例 NSTEMI 患者，根据世界银行的国家收入分类分层。根据 12 项指南推荐的护理干预措施，评估护理质量。采用全有或全无评分综合绩效指标来定义最佳护理的接受情况。结果包括院内急性心力衰竭、卒中和短暂性脑缺血发作以及死亡，以及 30 天死亡率。与 HIC 患者相比，收入较低和中下收入国家（LLMICs）的 NSTEMI 患者年龄较小，更常见糖尿病和吸烟者，但合并症负担较低，76.7% 符合立即进行有创策略的极高风险标准。随着收入分类的上升，侵入性冠状动脉造影的使用增加（LLMICs：79.2%；中高收入国家[UMICs]：83.7%；HICs：91.0%），但整体护理质量并未提高（≥80%符合条件的干预措施：LLMICs：64.8%；UMICs：69.6%；HICs：55.1%）。急性心力衰竭发生率（LLMICS：21.3%；UMICs：12.1%；HICs：6.8%；P<0.001）、卒中和短暂性脑缺血发作（LLMICS：2.5%；UMICs：1.5%；HICs：0.9%；P=0.04）、院内死亡率（LLMICS：3.6%；UMICs：2.8%；HICs：1.0%；P<0.001）和 30 天死亡率（LLMICS：4.9%；UMICs：3.9%；HICs：1.5%；P<0.001）呈负向经济梯度。