Department of Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
Berlin-Brandenburger Herzinfarktregister, Berlin, Germany.
Clin Res Cardiol. 2023 Sep;112(9):1240-1251. doi: 10.1007/s00392-023-02165-9. Epub 2023 Feb 11.
We investigated the implementation of new guidelines in ST-segment elevation myocardial infarction (STEMI) patients in a large real-world patient population in the metropolitan area of Berlin (Germany) over a 20-year period.
From January 2000 to December 2019, a total of 25 792 patients were admitted with STEMI to one of the 34 member hospitals of the Berlin-Brandenburg Myocardial Infarction Registry (B2HIR) and were stratified for sex and age < 75 and ≥ 75 years.
The median age of women was 72 years (IQR 61-81) compared to 61 years in men (IQR 51-71). PCI treatment as a standard of care was implemented in men earlier than in women across all age groups. It took two years from the 2017 class IA ESC STEMI guideline recommendation to prefer the radial access route rather than femoral until > 60% of patients were treated accordingly. In 2019, less than 60% of elderly women were treated via a radial access. While the majority of patients < 75 years already received ticagrelor or prasugrel as antiplatelet agent in the year of the class IA ESC STEMI guideline recommendation in 2012, men ≥ 75 years lagged two years and women ≥ 75 three years behind. Amongst the elderly, in-hospital mortality was 22.6% (737) for women and 17.3% (523) for men (p < 0.001). In patients < 75 years fatal outcome was less likely with 7.2% (305) in women and 5.8% (833) in men (p < 0.001). After adjustment for confounding variables, female sex was an independent predictor of in-hospital mortality in patients ≥ 75 years (OR 1.37, 95% CI 1.12-1.68, p = 0.002), but not in patients < 75 years (p = 0.076).
In-hospital mortality differs considerably by age and sex and remains highest in elderly patients and in particular in elderly females. In these patient groups, guideline recommended therapies were implemented with a significant delay.
我们研究了在柏林大都市地区（德国）的 20 年间，新指南在大量真实世界的 ST 段抬高型心肌梗死（STEMI）患者中的实施情况。
从 2000 年 1 月至 2019 年 12 月，共有 25792 例 STEMI 患者被收入柏林-勃兰登堡心肌梗死登记处（B2HIR）的 34 个成员医院之一，并按性别和年龄<75 岁和≥75 岁进行分层。
女性的中位年龄为 72 岁（IQR 61-81），而男性为 61 岁（IQR 51-71）。在所有年龄段，男性接受经皮冠状动脉介入治疗（PCI）作为标准治疗的时间早于女性。从 2017 年 ESC STEMI 类 IA 指南建议首选桡动脉入路而非股动脉入路，到有超过 60%的患者接受相应治疗，这一过程耗时两年。2019 年，不到 60%的老年女性接受桡动脉入路治疗。尽管 2012 年 ESC STEMI 类 IA 指南建议使用替格瑞洛或普拉格雷作为抗血小板药物，但大多数<75 岁的患者已经接受了这两种药物，而≥75 岁的男性和≥75 岁的女性则分别滞后了两年和三年。在老年人中，女性的院内死亡率为 22.6%（737 例），男性为 17.3%（523 例）（p<0.001）。在<75 岁的患者中，女性的致命结局可能性更小，为 7.2%（305 例），男性为 5.8%（833 例）（p<0.001）。在调整混杂变量后，女性是≥75 岁患者院内死亡的独立预测因素（OR 1.37，95%CI 1.12-1.68，p=0.002），但在<75 岁患者中则不然（p=0.076）。
院内死亡率在年龄和性别上有显著差异，在老年患者中尤其是老年女性中最高。在这些患者群体中，指南推荐的治疗方法实施存在显著延迟。
