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. 2023 Sep;112(9):1240-1251.
doi: 10.1007/s00392-023-02165-9. Epub 2023 Feb 11.

Implementation of the ESC STEMI guidelines in female and elderly patients over a 20-year period in a large German registry

Leonhard Riehle  1 , Raffaella M Gothe  2 , Jan Ebbinghaus  3 , Birga Maier  2 , Leonhard Bruch  4 , Jens-Uwe Röhnisch  5 , Helmut Schühlen  6 , Andreas Fried  2 , Martin Stockburger  7 , Heinz Theres  8 , Henryk Dreger  9 , David M Leistner  9 , Ulf Landmesser  9 , Georg M Fröhlich  9
Affiliations

Implementation of the ESC STEMI guidelines in female and elderly patients over a 20-year period in a large German registry

Leonhard Riehle et al. Clin Res Cardiol. 2023 Sep.

Abstract

Aims: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

Keywords: Coronary artery disease; Myocardial infarction; Percutaneous coronary intervention (PCI); ST-elevation myocardial infarction (STEMI); Women.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Major changes in recommendations for the treatment of STEMI in the ESC guidelines since 2003 ESC STEMI guideline [12, 24, 25, 47]. PCI percutaneous coronary intervention, DES drug-eluting stent, BMS bare-metal stent, FMC first medical contact
Fig. 2
Fig. 2
Median DTB in STEMI patients from 2008–2019 stratified for sex and age
Fig. 3
Fig. 3
STEMI patients receiving PCI-therapy from 2000–2019 stratified for sex and age
Fig. 4
Fig. 4
The radial access route for PCI from 2011 to 2019 stratified for sex and age
See this image and copyright information in PMC

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