Implementation of the ESC STEMI guidelines in female and elderly patients over a 20-year period in a large German registry
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...
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| Veröffentlicht in: | Clinical research in cardiology 2023-09, Vol.112 (9), p.1240-1251 |
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| creator | Riehle, Leonhard Gothe, Raffaella M. Ebbinghaus, Jan Maier, Birga Bruch, Leonhard Röhnisch, Jens-Uwe Schühlen, Helmut Fried, Andreas Stockburger, Martin Theres, Heinz Dreger, Henryk Leistner, David M. Landmesser, Ulf Fröhlich, Georg M. |
| description | 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 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 |
| doi_str_mv | 10.1007/s00392-023-02165-9 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10449958</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2856645717</sourcerecordid><originalsourceid>FETCH-LOGICAL-c475t-65b697b86f844c2d5fdb03d67f7fbe9bc65964788769e0d5996be0bc6594d93e3</originalsourceid><addsrcrecordid>eNp9kU9v1DAQxSNERUvhC3BAlrhwCXXif_EJodXSrtSKQ8vZcuJJ6sqxg51U2n56vN12gR44WLY8v_dmRq8oPlT4S4WxOEsYE1mXuCb5VJyV8lVxUjW8KjGX9evDu6HHxduU7jBmFSb0TXFMuOBUEnJSPGzGycEIftazDR6FHs23gNbXK3R9s77aoGGxBpz1kJD1qIdRO0DaGwTOQHRbNGVhlicU7iEijWpcbkFHNEG0wexEGjkdB0DnEEftUYTBpjlu3xVHvXYJ3j_dp8XP7-ub1UV5-eN8s_p2WXZUsLnkrOVStA3vG0q72rDetJgYLnrRtyDbjjPJqWgawSVgw6TkLeDHb2okAXJafN37Tks7gunysFE7NUU76rhVQVv1b8XbWzWEe1VhSqVkTXb4_OQQw68F0qxGmzpwTnsIS1K1EIzXnHKZ0U8v0LuwRJ_3U3XDOKdMVCJT9Z7qYkgpQn-YpsJql63aZ6tytuoxW7Wz_vj3HgfJc5gZIHsg5ZIfIP7p_R_b3wjur5g</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2856645717</pqid></control><display><type>article</type><title>Implementation of the ESC STEMI guidelines in female and elderly patients over a 20-year period in a large German registry</title><source>SpringerLink Journals - AutoHoldings</source><creator>Riehle, Leonhard ; Gothe, Raffaella M. ; Ebbinghaus, Jan ; Maier, Birga ; Bruch, Leonhard ; Röhnisch, Jens-Uwe ; Schühlen, Helmut ; Fried, Andreas ; Stockburger, Martin ; Theres, Heinz ; Dreger, Henryk ; Leistner, David M. ; Landmesser, Ulf ; Fröhlich, Georg M.</creator><creatorcontrib>Riehle, Leonhard ; Gothe, Raffaella M. ; Ebbinghaus, Jan ; Maier, Birga ; Bruch, Leonhard ; Röhnisch, Jens-Uwe ; Schühlen, Helmut ; Fried, Andreas ; Stockburger, Martin ; Theres, Heinz ; Dreger, Henryk ; Leistner, David M. ; Landmesser, Ulf ; Fröhlich, Georg M.</creatorcontrib><description><![CDATA[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.
Graphical abstract]]></description><identifier>ISSN: 1861-0684</identifier><identifier>EISSN: 1861-0692</identifier><identifier>DOI: 10.1007/s00392-023-02165-9</identifier><identifier>PMID: 36764933</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Access routes ; Age ; Cardiology ; Females ; Guidelines ; Heart attacks ; Hospitals ; Medicine ; Medicine & Public Health ; Men ; Metropolitan areas ; Mortality ; Myocardial infarction ; Older people ; Original Paper ; Patients ; Sex ; Women</subject><ispartof>Clinical research in cardiology, 2023-09, Vol.112 (9), p.1240-1251</ispartof><rights>The Author(s) 2023</rights><rights>2023. The Author(s).</rights><rights>The Author(s) 2023. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c475t-65b697b86f844c2d5fdb03d67f7fbe9bc65964788769e0d5996be0bc6594d93e3</citedby><cites>FETCH-LOGICAL-c475t-65b697b86f844c2d5fdb03d67f7fbe9bc65964788769e0d5996be0bc6594d93e3</cites><orcidid>0000-0002-1241-9285</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00392-023-02165-9$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00392-023-02165-9$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36764933$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Riehle, Leonhard</creatorcontrib><creatorcontrib>Gothe, Raffaella M.</creatorcontrib><creatorcontrib>Ebbinghaus, Jan</creatorcontrib><creatorcontrib>Maier, Birga</creatorcontrib><creatorcontrib>Bruch, Leonhard</creatorcontrib><creatorcontrib>Röhnisch, Jens-Uwe</creatorcontrib><creatorcontrib>Schühlen, Helmut</creatorcontrib><creatorcontrib>Fried, Andreas</creatorcontrib><creatorcontrib>Stockburger, Martin</creatorcontrib><creatorcontrib>Theres, Heinz</creatorcontrib><creatorcontrib>Dreger, Henryk</creatorcontrib><creatorcontrib>Leistner, David M.</creatorcontrib><creatorcontrib>Landmesser, Ulf</creatorcontrib><creatorcontrib>Fröhlich, Georg M.</creatorcontrib><title>Implementation of the ESC STEMI guidelines in female and elderly patients over a 20-year period in a large German registry</title><title>Clinical research in cardiology</title><addtitle>Clin Res Cardiol</addtitle><addtitle>Clin Res Cardiol</addtitle><description><![CDATA[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.
Graphical abstract]]></description><subject>Access routes</subject><subject>Age</subject><subject>Cardiology</subject><subject>Females</subject><subject>Guidelines</subject><subject>Heart attacks</subject><subject>Hospitals</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Men</subject><subject>Metropolitan areas</subject><subject>Mortality</subject><subject>Myocardial infarction</subject><subject>Older people</subject><subject>Original Paper</subject><subject>Patients</subject><subject>Sex</subject><subject>Women</subject><issn>1861-0684</issn><issn>1861-0692</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kU9v1DAQxSNERUvhC3BAlrhwCXXif_EJodXSrtSKQ8vZcuJJ6sqxg51U2n56vN12gR44WLY8v_dmRq8oPlT4S4WxOEsYE1mXuCb5VJyV8lVxUjW8KjGX9evDu6HHxduU7jBmFSb0TXFMuOBUEnJSPGzGycEIftazDR6FHs23gNbXK3R9s77aoGGxBpz1kJD1qIdRO0DaGwTOQHRbNGVhlicU7iEijWpcbkFHNEG0wexEGjkdB0DnEEftUYTBpjlu3xVHvXYJ3j_dp8XP7-ub1UV5-eN8s_p2WXZUsLnkrOVStA3vG0q72rDetJgYLnrRtyDbjjPJqWgawSVgw6TkLeDHb2okAXJafN37Tks7gunysFE7NUU76rhVQVv1b8XbWzWEe1VhSqVkTXb4_OQQw68F0qxGmzpwTnsIS1K1EIzXnHKZ0U8v0LuwRJ_3U3XDOKdMVCJT9Z7qYkgpQn-YpsJql63aZ6tytuoxW7Wz_vj3HgfJc5gZIHsg5ZIfIP7p_R_b3wjur5g</recordid><startdate>20230901</startdate><enddate>20230901</enddate><creator>Riehle, Leonhard</creator><creator>Gothe, Raffaella M.</creator><creator>Ebbinghaus, Jan</creator><creator>Maier, Birga</creator><creator>Bruch, Leonhard</creator><creator>Röhnisch, Jens-Uwe</creator><creator>Schühlen, Helmut</creator><creator>Fried, Andreas</creator><creator>Stockburger, Martin</creator><creator>Theres, Heinz</creator><creator>Dreger, Henryk</creator><creator>Leistner, David M.</creator><creator>Landmesser, Ulf</creator><creator>Fröhlich, Georg M.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7Z</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-1241-9285</orcidid></search><sort><creationdate>20230901</creationdate><title>Implementation of the ESC STEMI guidelines in female and elderly patients over a 20-year period in a large German registry</title><author>Riehle, Leonhard ; Gothe, Raffaella M. ; Ebbinghaus, Jan ; Maier, Birga ; Bruch, Leonhard ; Röhnisch, Jens-Uwe ; Schühlen, Helmut ; Fried, Andreas ; Stockburger, Martin ; Theres, Heinz ; Dreger, Henryk ; Leistner, David M. ; Landmesser, Ulf ; Fröhlich, Georg M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c475t-65b697b86f844c2d5fdb03d67f7fbe9bc65964788769e0d5996be0bc6594d93e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Access routes</topic><topic>Age</topic><topic>Cardiology</topic><topic>Females</topic><topic>Guidelines</topic><topic>Heart attacks</topic><topic>Hospitals</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Men</topic><topic>Metropolitan areas</topic><topic>Mortality</topic><topic>Myocardial infarction</topic><topic>Older people</topic><topic>Original Paper</topic><topic>Patients</topic><topic>Sex</topic><topic>Women</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Riehle, Leonhard</creatorcontrib><creatorcontrib>Gothe, Raffaella M.</creatorcontrib><creatorcontrib>Ebbinghaus, Jan</creatorcontrib><creatorcontrib>Maier, Birga</creatorcontrib><creatorcontrib>Bruch, Leonhard</creatorcontrib><creatorcontrib>Röhnisch, Jens-Uwe</creatorcontrib><creatorcontrib>Schühlen, Helmut</creatorcontrib><creatorcontrib>Fried, Andreas</creatorcontrib><creatorcontrib>Stockburger, Martin</creatorcontrib><creatorcontrib>Theres, Heinz</creatorcontrib><creatorcontrib>Dreger, Henryk</creatorcontrib><creatorcontrib>Leistner, David M.</creatorcontrib><creatorcontrib>Landmesser, Ulf</creatorcontrib><creatorcontrib>Fröhlich, Georg M.</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biochemistry Abstracts 1</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical research in cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Riehle, Leonhard</au><au>Gothe, Raffaella M.</au><au>Ebbinghaus, Jan</au><au>Maier, Birga</au><au>Bruch, Leonhard</au><au>Röhnisch, Jens-Uwe</au><au>Schühlen, Helmut</au><au>Fried, Andreas</au><au>Stockburger, Martin</au><au>Theres, Heinz</au><au>Dreger, Henryk</au><au>Leistner, David M.</au><au>Landmesser, Ulf</au><au>Fröhlich, Georg M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Implementation of the ESC STEMI guidelines in female and elderly patients over a 20-year period in a large German registry</atitle><jtitle>Clinical research in cardiology</jtitle><stitle>Clin Res Cardiol</stitle><addtitle>Clin Res Cardiol</addtitle><date>2023-09-01</date><risdate>2023</risdate><volume>112</volume><issue>9</issue><spage>1240</spage><epage>1251</epage><pages>1240-1251</pages><issn>1861-0684</issn><eissn>1861-0692</eissn><abstract><![CDATA[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.
Graphical abstract]]></abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>36764933</pmid><doi>10.1007/s00392-023-02165-9</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-1241-9285</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1861-0684 |
| ispartof | Clinical research in cardiology, 2023-09, Vol.112 (9), p.1240-1251 |
| issn | 1861-0684 1861-0692 |
| language | eng |
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| source | SpringerLink Journals - AutoHoldings |
| subjects | Access routes Age Cardiology Females Guidelines Heart attacks Hospitals Medicine Medicine & Public Health Men Metropolitan areas Mortality Myocardial infarction Older people Original Paper Patients Sex Women |
| title | Implementation of the ESC STEMI guidelines in female and elderly patients over a 20-year period in a large German registry |
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