Among 64,025 STEMI patients in four European national registries, 1-year mortality ranged from 14.8% in Sweden to 21.1% in Estonia, reflecting variations in baseline risk and clinical management.
Observational (n=64,025)
Yes
How do patient characteristics, management, and outcomes of STEMI vary across national registries in Estonia, Hungary, Norway, and Sweden?
Significant inter-country variations exist in the management and outcomes of STEMI patients across European registries, with higher reperfusion rates and guideline-directed medical therapy use correlating with lower mortality.
AIMS: Describe the characteristics, management and outcomes of hospitalized ST-segment elevation myocardial infarction (STEMI) patients according to national ongoing myocardial infarction registries in Estonia, Hungary, Norway, and Sweden. METHODS AND RESULTS: Country-level aggregated data was used to study baseline characteristics, use of in-hospital procedures, medications at discharge, in-hospital complications, 30-day and 1-year mortality for all patients admitted with STEMI during 2014-2017 using data from EMIR (Estonia; n = 4584), HUMIR (Hungary; n = 23 685), NORMI (Norway; n = 12 414, data for 2013-2016), and SWEDEHEART (Sweden; n = 23 342). Estonia and Hungary had a higher proportion of women, patients with hypertension, diabetes, and peripheral artery disease compared to Norway and Sweden. Rates of reperfusion varied from 75.7% in Estonia to 84.0% in Sweden. Rates of recommendation of discharge medications were generally high and similar. However, Estonia demonstrated the lowest rates of dual antiplatelet therapy (78.1%) and statins (86.5%). Norway had the lowest rates of beta-blockers (80.5%) and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (61.5%). The 30-day mortality rates ranged between 9.9% and 13.4% remaining lowest in Sweden. One-year mortality rates ranged from 14.8% in Sweden and 16.0% in Norway to 20.6% in Hungary and 21.1% in Estonia. Age-adjusted lethality rates were highest for Hungary and lowest for Sweden. CONCLUSION: This inter-country comparison of data from four national ongoing European registries provides new insights into the risk factors, management and outcomes of patients with STEMI. There are several possible reasons for the findings, including coverage of the registries and variability of baseline-characteristics' definitions that need to be further explored.
Blöndal et al. (Wed,) conducted a observational in ST-segment elevation myocardial infarction (STEMI) (n=64,025). Among 64,025 STEMI patients in four European national registries, 1-year mortality ranged from 14.8% in Sweden to 21.1% in Estonia, reflecting variations in baseline risk and clinical management.