Background
Methods
The Bremen STEMI-registry (BSR)
Definition of STEMI and disease severity
The Bremen social deprivation index
Statistical analysis
Results
Study population
G1 (high SES) | G2 (intermediate high SES) | G3 (intermediate low SES) | G4 (low SES) | |
---|---|---|---|---|
% of total population | 19 | 24 | 43 | 14 |
Inhabitants <19 yrs. of age (%) | 14 | 13 | 15 | 19 |
STEMIs 2006–2016 (n) | 519 | 813 | 1554 | 576 |
SDI by definition | ≥56 | 0 to 56 | −56 to 0 | ≤ −56 |
SDI range | 99 to 56 | 50 to 1 | −3 to −50 | −59 to −121 |
Mean SDI±SD | 78 ± 16 | 26 ± 18 | −31 ± 16 | −86 ± 29 |
Incidence of STEMI
G1 | G2 | G3 | G4 | ||
---|---|---|---|---|---|
All STEMIs | Population at risk | 87,783 | 114,107 | 200,548 | 64,087 |
Events a
| 519 | 813 | 1554 | 576 | |
Incidence rate (IR/ 95%CI) | 59 (54–65) | 71 (66–76) | 77 (74–81) | 90 (83–98) | |
Men | Population at risk | 41,345 | 58,548 | 102,460 | 32,357 |
Events a
| 352 | 576 | 1097 | 407 | |
Incidence rate (IR/ 95%CI) | 85 (77–95) | 98 (91–107) | 107 (101–114) | 126 (114–139) | |
Women | Population at risk | 46,438 | 55,559 | 98,088 | 31,730 |
Events a
| 167 | 237 | 457 | 169 | |
Incidence rate (IR/ 95%CI) | 36 (31–42) | 43 (37–48) | 47(42–51) | 53 (46–62) | |
Age 18–49 | Population at risk | 42,972 | 61,834 | 104,873 | 33,326 |
Events a
| 57 | 139 | 229 | 100 | |
Incidence rate (IR/ 95%CI) | 13 (10–17) | 22 (19–27) | 22(19–25) | 30 (24–36) | |
Age 50–64 | Population at risk | 19,873 | 26,569 | 44,815 | 14,861 |
Events a
| 143 | 267 | 533 | 203 | |
Incidence rate (IR/ 95%CI) | 72 (61–85) | 100 (89–113) | 119(109–130) | 137 (118–157) | |
Age 65–79 | Population at risk | 18,171 | 18,524 | 37,191 | 11,863 |
Events a
| 216 | 293 | 579 | 208 | |
Incidence rate (IR/ 95%CI) | 118 (103–136) | 158 (141–177) | 156(143–168) | 175 (154–202) | |
Age > 79 | Population at risk | 6767 | 7180 | 13,669 | 4037 |
Events a
| 103 | 114 | 213 | 65 | |
Incidence rate (IR/ 95%CI) | 152 (124–185) | 159 (131–191) | 156(137–178) | 161 (124–205) |
Baseline characteristics of STEMI-patients
G1 (n = 519) | G2 (n = 813) | G3 (n = 1554) | G4 (n = 576) | p-value | |
---|---|---|---|---|---|
Age (yrs) ± SD | 67.6 ± 13 | 64.1 ± 13 | 63.1 ± 13 | 63.1 ± 13 | <0.01 |
Female Gender (%) | 31.8 | 29.1 | 29.4 | 29.3 | 0.08 |
Smoking (%) | 33.3 | 44.2 | 45.9 | 49.1 | <0.01 |
Mean BMI (kg/sqm) ± SD | 26.7 ± 5 | 27.3 ± 5 | 27.6 ± 5 | 27.9 ± 5 | <0.01 |
BMI > 30 kg/sqm (%) | 17.0 | 21.4 | 25.2 | 26.8 | <0.01 |
Diabetes mellitus (%) | 18.8 | 21.9 | 20.5 | 20.4 | 0.3 |
Family history (FH) for CAD (%) | 22.2 | 22.3 | 18.6 | 18.5 | 0.02 |
Known CV disease (%) | 23.8 | 24.8 | 27.5 | 24.6 | 0.9 |
Severity of STEMI
G1 (n = 519) | G2 (n = 813) | G3 (n = 1554) | G4 (n = 576) | p-value | |
---|---|---|---|---|---|
Severity of myocardial infarction | |||||
Number of coronary vesssels affected ±SD | 1.99 ± 0.8 | 1.94 ± 0.8 | 1.91 ± 0.8 | 1.84 ± 0.8 | 0.09 |
Cardiogenic shock (%) | 12.1 | 13.1 | 12.0 | 12.4 | 0.8 |
Prehospital CPR (%) | 10.9 | 11.3 | 10.8 | 10.3 | 0.5 |
Subacute MI(%) a
| 19.3 | 23.9 | 20.5 | 19.9 | 0.8 |
Mean peak CK (U/l) ± SD | 1599 ± 1679 | 1838 ± 2019 | 1913 ± 2188 | 2025 ± 2167 | <0.01 |
Peak CK > 3000 U/l (%) | 13.7 | 20.5 | 20.9 | 23.3 | <0.01 |
Post AMI LVEF in % ± SD | 49.6 ± 9 | 48.9 ± 10 | 48.4 ± 11 | 47.5 ± 10 | <0.01 |
LVEF <40% (%) | 10.4 | 13.8 | 15.8 | 16.3 | 0.01 |
Treatment modalitites | |||||
Primary PCI (%) | 89.0 | 91.1 | 89.9 | 90.9 | 0.9 |
CABG (%) | 6.1 | 3.9 | 4.8 | 3.4 | 0.14 |
Conservative therapy regimen (%) | 4.8 | 4.9 | 5.2 | 5.7 | 0.8 |
Door to balloon time in min (median ± SD) | 48 ± 32 | 43 ± 44.5 | 46 ± 40 | 44 ± 41 | 0.74 |
GP2b3a-Inhibitors (%) | 70 | 67 | 66 | 70 | 0.7 |
ASA (at discharge) (%) | 94 | 96 | 94 | 95 | 0.64 |
ADP-Antagon. (ad) (%) | 90 | 90.5 | 90 | 94 | 0.23 |
Beta-blockers (ad) (%) | 83 | 84 | 80 | 84 | 0.25 |
Statins (ad) (%) | 86 | 87 | 87 | 86 | 0.9 |
ACE/ATR-Inhibitors (ad) (%) | 77 | 80 | 79 | 79 | 0.9 |
Outcome | |||||
Mortality <72 h (%) | 3.9 | 3.6 | 3.9 | 4.2 | 0.71 |
Inhospital mortality (%) | 8.8 | 7.6 | 7.9 | 8.1 | 0.71 |
1-year-mortality (%) | 15.7 | 15.1 | 14.9 | 16.3 | 0.9 |
1-year-MACCE (%) | 19.2 | 19.5 | 19.1 | 20.4 | 0.8 |
5-year-mortality (%) | 23.9 | 27.7 | 25.7 | 28.3 | 0.46 |
5-year-MACCE (%) | 30.8 | 35.7 | 36.0 | 41.1 | 0.02 |