Article Text
Abstract
Objective To assess temporal trends of in-hospital mortality in patients with acute myocardial infarction (AMI) enrolled in the Swiss nationwide registry (AMIS Plus) over the last 20 years with regard to gender, age and in-hospital treatment.
Methods All patients with AMI from 1997 to 2016 were stratified according to ST-segment elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI), and gender using logistic regression analyses.
Results Among 51 725 patients, 30 398 (59%) had STEMI and 21 327 (41%) had NSTEMI; 73% were men (63.9±12.8 years) and 27% were women (71.7±12.5 years). Over 20 years, crude in-hospital STEMI mortality decreased from 9.8% to 5.5% in men and from 18.3% to 6.9% in women. In patients with NSTEMI, it decreased from 7.1% to 2.1% in men and from 11.0% to 3.6% in women. After adjustment for age, mortality decreased per additional admission year by 3% in men with STEMI (OR 0.97, 95% CI 0.96 to 0.98, P<0.001), by 5% in women with STEMI (OR 0.95, 95% CI 0.93 to 0.96, P<0.001), by 6% in men with NSTEMI (OR 0.94, 95% CI 0.93 to 0.96, P<0.001) and by 5% in women with NSTEMI (OR 0.95, 95% CI 0.93 to 0.97, P<0.001). In patients <60 years, a decrease in mortality was seen in women with STEMI (OR 0.94, 95% CI 0.90 to 0.99, P=0.025) and NSTEMI (OR 0.87, 95% CI 0.80 to 0.94, P<0.001) but not in men with STEMI (OR 1.01, 95% CI 0.98 to 1.04, P=0.46) and NSTEMI (OR 0.98, 95% CI 0.94 to 1.03, P=0.41). The mortality decrease in patients with AMI was closely associated with the increase in reperfusion therapy.
Conclusion From 1997 to 2016, in-hospital mortality of patients with AMI in Switzerland has halved and was more pronounced in women, particularly in the age category <60 years.
Trial registration number NCT01305785; Results.
- STEMI
- NSTEMI
- gender
- coronary intervention (PCI)
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Footnotes
Contributors DR: conception and design, analysis and interpretation of data, drafting of the article. BS: analysis and interpretation of data, critical revision of manuscript and final approval of the manuscript. MR, PU, HR and GP: acquisition of data, critical revision of manuscript for intellectual content and final approval of the manuscript. PE: acquisition of data, conception and design, critical revision of manuscript for intellectual content and final approval of the manuscript.
Funding The AMIS Plus registry is funded by unrestricted grants from the Swiss Heart Foundation and from Abbot AG, Amgen AG, AstraZeneca AG, Bayer (Schweiz) AG, B. Braun Medical AG, Biotronik AG, Boston Scientific AG, Cordis-Cardinal Health, Daiichi-Sankyo/Eli Lilly AG, GE Healthcare, Medtronic AG, A Menarini AG, Mepha Pharma AG, Merck Sharp & Dohme-Chibret AG, Novartis Pharma Schweiz AG, Pfizer AG, Servier (Suisse) AG, St. Jude Medical and Vascular Medical AG, all in Switzerland.
Disclaimer The sponsors did not play any role in the design, data collection, analysis or interpretation of the registry.
Competing interests None declared.
Ethics approval Swiss Supra-Regional Ethics Committee for Clinical Studies, the Swiss Board for Data Security and the Cantonal Ethics Commissions.
Provenance and peer review Not commissioned; internally peer reviewed.
Data sharing statement According to the AMIS Plus regulations, there are access restrictions to the individual data used as these are the property of the hospitals participating in the AMIS Plus registry and may only be made available by each hospital principal investigator and the AMIS Plus Steering Committee. This also applies to any analysis files or parts thereof used in this study.
Collaborators The authors would like to express their gratitude to the teams of the following hospitals (listed in alphabetical order with the names of the local principal investigators): Aarau, Kantonsspital (P Lessing); Affoltern am Albis, Spital (F Hess); Altdorf, Kantonsspital Uri (RSimon); Altstätten, Spital (P J Hangartner); Baden, Kantonsspital (UHufschmid); Basel, St. Claraspital (B Hornig/L Altwegg); Basel, Universitätsspital (R Jeger); Bern, Beau-Site Klinik (S Trummler); Bern, Inselspital (S Windecker, T Pilgrim); Bern, HirslandenSalem-Spital (T Rueff); Bern, Tiefenauspital (P Loretan); Biel, Spitalzentrum (C Roethlisberger); Brig-Glis, Oberwalliser Kreisspital (D Evéquoz); Bülach, Spital (G Mang); Burgdorf, RegionalspitalEmmental (D Ryser); Chur, Rätisches Kantons- und Regionalspital (PMüller); Chur, Kreuzspital (R Jecker); Davos, Spital (W Kistler); Dornach, Spital (T Hongler); Einsiedeln, Regionalspital (S Stäuble); Flawil, Spital (G Freiwald); Frauenfeld Kantonsspital (HP Schmid); Fribourg, Hôpital cantonal (JC Stauffer/S Cook); Frutigen, Spital (KBietenhard); Genève, Hôpitaux universitaires (M Roffi); Glarus, Kantonsspital (W. Wojtyna); Grenchen, Spital (R.Schönenberger); Grosshöchstetten, Bezirksspital (C Simonin); Heiden, KantonalesSpital (R Waldburger); Herisau, Kantonales Spital (M Schmidli); Horgen, See Spital (B Federspiel); Interlaken, Spital (EM Weiss); Jegenstorf, Spital (H Marty); Kreuzlingen, Herzzentrum Bodensee (KWeber); La Chaux-de-Fonds, Hôpital (H Zender); Lachen, Regionalspital (I Poepping); Langnau im Emmental, Regionalspital (AHugi); Laufenburg, Gesundheitszentrum Fricktal (E Koltai); Lausanne, Centre Hospitalier Universitaire Vaudois (JF Iglesias); Lugano, Cardiocentro Ticino (G Pedrazzini); Luzern, Luzerner Kantonsspital (PErne, F. Cuculi); Luzern Klinik St. Anna (P Erne); Männedorf,Kreisspital (T Heimes); Martigny, Hôpital régional (B Jordan); Mendrisio, Ospedale regionale (A Pagnamenta); Meyrin, Hôpital de laTour (P Urban); Monthey, Hôpital du Chablais (P Feraud); Montreux, Hôpital de Zone (E Beretta); Moutier, Hôpital du Jura bernois (CStettler); Münsingen, Spital (F Repond); Münsterlingen,Kantonsspital (F Widmer); Muri, Kreisspital für das Freiamt (CHeimgartner); Nyon, Group. Hosp. Ouest lémanique (R Polikar); Olten,Kantonsspital (S Bassetti); Rheinfelden, Gesundheitszentrum Fricktal(HU Iselin); Rorschach, Spital (M Giger); Samedan, Spital Oberengadin(P Egger); Sarnen, Kantonsspital Obwalden (T Kaeslin); Schaffhausen,Kantonsspital (A Fischer); Schlieren, Spital Limmattal (T Herren); Schwyz, Spital (P Eichhorn); Scuol, Ospidal d’Engiadina Bassa (CNeumeier/G Flury); Sion, Hôpital du Valais (G Girod); Solothurn, Bürgerspital (R Vogel); Stans, Kantonsspital Nidwalden (B Niggli); St. Gallen, Kantonsspital (H Rickli); Sursee, Luzerner Kantonsspital (S Yoon, J Nossen); Thun, Spital (U Stoller); Thusis, Krankenhaus (UPVeragut); Uster, Spital (E Bächli); Uznach, Spital Linth (A Weber); Walenstadt, Kantonales Spital (D Schmidt/J Hellermann); Wetzikon, GZOSpital (U Eriksson); Winterthur, Kantonsspital (T Fischer); Wolhusen,Luzener Kantonsspital (M Peter); Zofingen, Spital (S Gasser); Zollikerberg, Spital (R Fatio); Zug, Kantonsspital (M Vogt/D Ramsay); Zürich, Hirslanden Klinik (C Wyss); Zürich, Hirslanden Klinik imPark (O Bertel); Zürich, Universitätsspital (M Maggiorini); Zürich, Stadtspital Triemli (F Eberli); Zürich, Stadtspital Waid (SChristen).