Key result
Regional differences in clinical presentation, such as major symptoms and STEMI frequency, explain the decreasing 28-day case fatality gradient from northern (7%) to south-western France (2%).
Observational
Yes
The north-to-south decreasing gradient in case fatality rates for acute coronary events in France is partly explained by regional differences in the severity of clinical, biological, and electrocardiographic presentations at admission.
Regional ACS presentation differences may explain French mortality gradients; leaves open whether targeted strategies could reduce disparities.
BACKGROUND: In France, there is a large north-to-south, decreasing gradient in case fatality rates of hospitalized patients for an acute coronary event. This gradient may be explained by differences in the presenting patients' clinical, biological and electrocardiographic characteristics. GOAL: To compare the characteristics of patients hospitalized for an acute episode of coronary insufficiency in three regions of France with contrasting fatality rates. METHODS: We assessed all men and women (aged 35-74 years) covered by the MONICA registries in three geographical areas (north, east and south-west France) and hospitalized in 2006 for a first acute coronary event. The symptoms, electrocardiogram features, left ventricular ejection fraction (LVEF) and troponin levels were systematically transcribed from medical files. Vital status was followed up for one year. RESULTS: Fatality rates at 28 days and 1 year were higher in the north (7% and 12%, respectively) than in the east (5% and 7%) and in the south-west (2% and 5%). Major symptoms (such as cardiac arrest, acute pulmonary oedema and cardiac shock), altered LVEF and ST+ myocardial infarction (STEMI) were more frequent in the north than in the south-west (all p < 0.0001) - pointing to marked inter-regional differences in the presentation of acute coronary syndromes (ACSs). In multivariate analyses, age, major symptoms, altered LVEF and STEMI remained strongly associated with 28-day lethality, whereas the relationship with geographical area was attenuated. Similar results were observed for 1-year outcomes. CONCLUSIONS: The clinical, biological and electrocardiographic presentations of hospitalized incident ACSs differ from one region of France to another. These differences explain (at least in part) the 28-day and 1-year decreasing case fatality gradient in hospitalized patients from northern France to south-western France.
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Montaye et al. (2012) conducted an observational in First acute coronary event. Geographical region (North vs East vs South-West France) was evaluated on Fatality rates at 28 days and 1 year. Regional differences in clinical presentation, such as major symptoms and STEMI frequency, explain the decreasing 28-day case fatality gradient from northern (7%) to south-western France (2%).
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