Patients with implanted cardiac devices presenting with STEMI had a significantly increased risk of all-cause mortality at 5 years compared to those without devices (aHR 1.12).
Cohort (n=322,890)
Sí
Does the presence of an implanted cardiac device worsen quality of care and long-term mortality in patients presenting with STEMI?
STEMI patients with implanted cardiac devices experience significant delays in reperfusion therapy and have a higher risk of long-term mortality compared to those without devices.
Estimación del efecto: aHR 1.12 (95% CI 1.05-1.20)
Tasa de eventos absoluta: 55% vs 25%
valor p: p=<0.001
Abstract Introduction There is a growing population with cardiac devices (pacemakers, implantable cardioverter defibrillators and cardiac resynchronization therapy), but whether this influences quality of care and long-term mortality after ST-elevation myocardial infarction (STEMI) is unknown. Methods and results Patients in England and Wales between January 2005 and March 2019 with a diagnosis of STEMI were included from the Myocardial Ischaemia National Audit Project, Hospital Episode Statistics and mortality linkage to July 2021. Primary outcomes were all-cause mortality over the study period, secondary outcomes were odds of undergoing reperfusion within guideline mandated timeframes. Multivariate cox-models compared all-cause mortality over specified time-periods and logistic regression models illustrated odds of undergoing reperfusion. 322 890 patients with STEMI were included, 2118 (0.7%) had a cardiac device at STEMI admission. Patients with cardiac devices were older (78 years old vs. 66 years old) and more often female (32% vs. 29%) (P 0.001). After multivariate adjustment, patients with cardiac devices were less likely to have a ‘door-to-balloon time’ of under 60 min (aOR 0.61 95% CI 0.54–0.70) (P 0.001). Patients with cardiac devices had an increased risk of all-cause mortality at 5-years (aHR 1.12 95% CI 1.05–1.20) (P 0.001). Excluding patients dying within 30 days of admission, patients with cardiac devices still had a higher risk of death at 5-years (aHR 1.23 95% CI 1.13–1.33) (all P 0.001). Conclusion Patients with cardiac devices were less likely to undergo revascularization for STEMI within guideline mandated timeframes. They remain at elevated risk of all-cause mortality up to 5-years compared with STEMI patients without cardiac devices.
Weight et al. (Tue,) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=322,890). Implanted cardiac device vs. No implanted cardiac device was evaluated on All-cause mortality at 5 years (aHR 1.12, 95% CI 1.05-1.20, p=<0.001). Patients with implanted cardiac devices presenting with STEMI had a significantly increased risk of all-cause mortality at 5 years compared to those without devices (aHR 1.12).