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Comparative Study
. 2020 Jan 1;116(1):149-157.
doi: 10.1093/cvr/cvz197.

Statistics on mortality following acute myocardial infarction in 842 897 Europeans

Oras A Alabas  1 , Tomas Jernberg  2 , Mar Pujades-Rodriguez  3 , Mark J Rutherford  4 , Robert M West  3 , Marlous Hall  5 , Adam Timmis  6 , Bertil Lindahl  7 , Keith A A Fox  8 , Harry Hemingway  9   10   11 , Chris P Gale  5   12
Affiliations
Comparative Study

Statistics on mortality following acute myocardial infarction in 842 897 Europeans

Oras A Alabas et al. Cardiovasc Res. .

Abstract

Aims: To compare ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) mortality between Sweden and the UK, adjusting for background population rates of expected death, case mix, and treatments.

Methods and results: National data were collected from hospitals in Sweden [n = 73 hospitals, 180 368 patients, Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART)] and the UK [n = 247, 662 529 patients, Myocardial Ischaemia National Audit Project (MINAP)] between 2003 and 2013. There were lower rates of revascularization [STEMI (43.8% vs. 74.9%); NSTEMI (27.5% vs. 43.6%)] and pharmacotherapies at time of hospital discharge including [aspirin (82.9% vs. 90.2%) and (79.9% vs. 88.0%), β-blockers (73.4% vs. 86.4%) and (65.3% vs. 85.1%)] in the UK compared with Sweden, respectively. Standardized net probability of death (NPD) between admission and 1 month was higher in the UK for STEMI [8.0 (95% confidence interval 7.4-8.5) vs. 6.7 (6.5-6.9)] and NSTEMI [6.8 (6.4-7.2) vs. 4.9 (4.7-5.0)]. Between 6 months and 1 year and more than 1 year, NPD remained higher in the UK for NSTEMI [2.9 (2.5-3.3) vs. 2.3 (2.2-2.5)] and [21.4 (20.0-22.8) vs. 18.3 (17.6-19.0)], but was similar for STEMI [0.7 (0.4-1.0) vs. 0.9 (0.7-1.0)] and [8.4 (6.7-10.1) vs. 8.3 (7.5-9.1)].

Conclusion: Short-term mortality following STEMI and NSTEMI was higher in the UK compared with Sweden. Mid- and longer-term mortality remained higher in the UK for NSTEMI but was similar for STEMI. Differences in mortality may be due to differential use of guideline-indicated treatments.

Keywords: Acute myocardial infarction; MINAP; Mortality; SWEDEHEART; Sweden; UK.

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Conflict of interest statement

Conflict of Interest Disclosures

All authors have completed and submitted the ICMJ form for Potential Conflicts of Interest at www.icmje.org/coi_disclosure.pdf. Prof Fox reports receipt of grants and/or personal fees from Bayer/Janssen, AstraZeneca, Sanofi/Regeneron and Verseon. Prof Gale reports receipt of personal fees and/or nonfinancial support from AstraZeneca, Novartis, Bristol Myers Squibb, Bayer and Vifor Pharma. No support from any organisations that might have an interest in the submitted work and no other relationships or activities that could appear to have influenced the submitted work were reported.

Figures

Figure 1
Figure 1. STROBE diagram of exclusion of cases from the SWEDEHEART and MINAP datasets, to derive the analytical cohort.
Figure 2
Figure 2. Adjusted standardised net cumulative probability of death for STEMI for:
A) admission to 1 month post-AMI discharge; B) 1 month to 6 months; C) 6 months to 1 year; and D) over 1 year post-AMI.
Figure 3
Figure 3. Adjusted standardised net cumulative probability of death for NSTEMI for:
A) admission to 1 month post-AMI discharge; B) 1 month to 6 months; C) 6 months to 1 year; and D) over 1 year post-AMI.
Figure 4
Figure 4. Adjusted net probability of death estimates with and without standardisation for STEMI, in Sweden (A) and in the UK (B).
Figure 5
Figure 5. Adjusted net probability of death estimates with and without standardisation for NSTEMI, in Sweden (A) and in the UK (B).
See this image and copyright information in PMC

Comment in

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