Presentation, care, and outcomes of patients with NSTEMI according to World Bank country income classification: the ACVC-EAPCI EORP NSTEMI Registry of the European Society of Cardiology-Reference-Cited by-同舟云学术

Presentation, care, and outcomes of patients with NSTEMI according to World Bank country income classification: the ACVC-EAPCI EORP NSTEMI Registry of the European Society of Cardiology

Published:2023-02-03 Issue:6 Volume:9 Page:552-563
ISSN:2058-5225
Container-title:European Heart Journal - Quality of Care and Clinical Outcomes
language:en
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Nadarajah Ramesh¹²³^ORCID,Ludman Peter⁴^ORCID,Laroche Cécile⁵,Appelman Yolande⁶^ORCID,Brugaletta Salvatore⁷⁸^ORCID,Budaj Andrzej⁹^ORCID,Bueno Hector¹⁰¹¹¹²^ORCID,Huber Kurt¹³¹⁴^ORCID,Kunadian Vijay¹⁵¹⁶^ORCID,Leonardi Sergio¹⁷¹⁸^ORCID,Lettino Maddalena¹⁹^ORCID,Milasinovic Dejan²⁰^ORCID,Gale Chris P¹²³^ORCID,Vahanian A,Budaj A,Dagres N,Danchin N,Delgado V,Emberson J,Friberg O,Gale C P,Heyndrickx G,Iung B,James S,Kappetein A P,Maggioni A P,Maniadakis N,Nagy K V,Parati G,Petronio A-S,Pietila M,Prescott E,Ruschitzka F,Van de Werf F,Weidinger F,Zeymer U,Gale C P,Beleslin B,Budaj A,Chioncel O,Dagres N,Danchin N,Emberson J,Erlinge D,Glikson M,Gray A,Kayikcioglu M,Maggioni A P,Nagy K V,Nedoshivin A,Petronio A-P,Roos-Hesselink J W,Wallentin L,Zeymer U,Popescu B A,Adlam D,Caforio A L P,Capodanno D,Dweck M,Erlinge D,Glikson M,Hausleiter J,Iung B,Kayikcioglu M,Ludman P,Lund L,Maggioni A P,Matskeplishvili S,Meder B,Nagy K V,Nedoshivin A,Neglia D,Pasquet A A,Roos-Hesselink J W,Rossello F J,Shaheen S M,Torbica A,Gale Christopher Peter,Ludman Peter F,Lettino Maddalena^ORCID,Bueno Hector^ORCID,Huber Kurt^ORCID,Leonardi Sergio^ORCID,Budaj Andrzej^ORCID,Milasinovic Dejan^ORCID,Brugaletta Salvatore^ORCID,Appelman Yolande,Kunadian Vijay^ORCID,Mahmeed Wael Abdul Rahman Al,Kzhdryan Hovhannes,Dumont Carlos,Geppert Alexander,Bajramovic Nirvana Sabanovic,Cader Fathima Aaysha,Beauloye Christophe,Quesada Daniel,Hlinomaz Ota,Liebetrau Christoph,Marandi Toomas,Shokry Khaled,Bueno Héctor,Mansourati Jacques,Gale Chris P^ORCID,Maisuradze David,Sinanis Theodoros,Dharma Surya,Orvin Katia,Sinha Ajay,Farhan Hasan Ali,Sadeghipour Parham,Gudmundsdottir Ingibjorg,Indolfi Ciro,Kitai Takeshi,Mirrakhimov Erkin,Gustiene Olivija,Philippe François,Erglis Andrejs,Popovici Mihail,Kalpak Oliver,Dagva Mungunchimeg,Xuereb Robert George,Ahmad Wan Azman Wan,Appelman Yolande,Nadar Sunil K,Qamar Nadeem,Gierlotka Marek,Monteiro Silvia,Dan Gheorghe-Andrei,Radovanovic Mina,Reznik Elena Vladimirovna,Balghith Mohammed,Mohamed Awad,Cercek Miha,Brozmannová Denisa,Aytekin Vedat,Ingabire Prossie,Alyavi Baxrom,Cartasegna L,Gomez V Nomberto,Beltrano C,Novas V,Dumont C,Balparda H,Cardona M,Cigalini C,Hoyle V,Dámaso E San,Tapia V,Poghosyan K,Mkhitaryan S,Adamyan M,Boyadjian S,Hayrapetyan H,Azaryan K,Tadevosyan M,Poghosyan H,Kzhdryan H,Vardanyan A,Huber K,Geppert A,Ahmed A,Weidinger F,Derntl M,Hasun M,Schuh-Eiring T,Riegler L,Haq M M,Cader F A,Dewan M A-M,Fatema M-E,Hasan A S,Islam M M,Khandoker F,Mayedah R,Nizam S U,Azam M G,Arefin M M,Jahan J,Schelfaut D,De Raedt H,Wouters S,Aerts S,Batjoens H,Beauloye C,Dechamps M,Pierard S,Van Caenegem O,Sinnaeve F,Claeys M J,Snepvangers M,Somers V,Gevaert S,Schaubroek H,Vervaet P,Buysse M,Renders F,Dumoulein M,Hiltrop N,De Coninck M,Naessens S,Senesael I,Hoffer E,Pourbaix S,Beckers J,Dugauquier C,Jacquet S,Malmendier D,Massoz M,Evrard P,Collard L,Brunner P,Carlier S,Blockmans M,Mayne D,Timiras E,Guédès A,Demeure F,Hanet C,Domange J,Jourdan K,Begic E,Custovic F,Dozic A,Hrvat E,Kurbasic I,Mackic D,Subo A,Durak-Nalbantic A,Dzubur A,Rebic D,Hamzic-Mehmedbasic A,Redzepovic A,Djokic-Vejzovic A,Hodzic E,Hujdur M,Musija E,Gljiva-Gogic Z,Serdarevic N,Bajramovic N Sabanovic,Brigic L,Halilcevic M,Cibo M,Hadžibegic N,Kukavica N,Begic A,Iglica A,Osmanagic A,Resic N,Grgurevic M Vucijak,Zvizdic F,Pojskic B,Mujaric E,Selimovic H,Ejubovic M,Pojskic L,Stimjanin E,Sut M,Zapata P Sanchez,Munoz C Gallego,Andrade L A Fajardo,Upegui M P Tobon,Perez L E,Chavarria J,Quesada D,Alvarado K,Zaputovic L,Tomulic V,Gobic D,Jakljevic T,Lulic D,Bacic G,Bastiancic L,Avraamides P,Eftychiou C,Eteocleous N,Ioannou A,Lambrianidi C,Drakomathioulakis M,Groch L,Hlinomaz O,Rezek M,Semenka J,Sitar J,Beranova M,Kramarikova P,Pesl L,Sindelarova S,Tousek F,Warda H M,Ghaly I,Habiba S,Habib A,Gergis M N,Bahaa H,Samir A,Taha H Salah Eldin,Adel M,Algamal H Mahrous,Mamdouh M,Shaker A Foad,Shokry K,Konsoah A,Mostafa A Magdy,Ibrahim A,Imam A,Hafez B,Zahran A,Abdelhamid M,Mahmoud K,Mostafa A,Samir A,Abdrabou M,Kamal A,Sallam S,Ali A,Maghraby K,Atta A Radi,Saad A,Ali M,Lotman E-M,Lubi R,Kaljumäe H,Uuetoa T,Kiitam U,Durier C,Ressencourt O,El Din A Alaa,Guiatni A,Bras M Le,Mougenot E,Labeque J-N,Banos J-L,Capendeguy O,Mansourati J,Fofana A,Augagneur M,Bahon L,Pape A Le,Batias-Moreau L,Fluttaz A,Good F,Prieur F,Boiffard E,Derien A-S,Drapeau I,Roy N,Perret T,Dubreuil O,Ranc S,Rio S,Bonnet J-L,Bonnet G,Cuisset T,Deharo P,Mouret J-P,Spychaj J-C,Blondelon A,Delarche N,Decalf V,Guillard N,Hakme A,Roger M-P,Biron Y,Druelles P,Loubeyre C,Lucon A,Hery P,Nejjari M,Digne F,Huchet F,Neykova A,Tzvetkov B,Larrieu M,Quaino G,Armangau P,Sauguet A,Bonfils L,Dumonteil N,Fajadet J,Farah B,Honton B,Monteil B,Philippart R,Tchetche D,Cottin M,Petit F,Piquart A,Popovic B,Varlot J,Maisuradze D,Sagirashvili E,Kereselidze Z,Totladze L,Ginturi T,Lagvilava D,Hamm C,Liebetrau C,Haas M,Hamm C,Koerschgen T,Weferling M,Wolter J-S,Maier K,Nickenig G,Sedaghat A,Zachoval C,Lampropoulos K,Mpatsouli A,Sakellaropoulou A,Tyrovolas K,Zibounoumi N,Argyropoulos K,Toulgaridis F,Kolyviras A,Tzanis G,Tzifos V,Milkas A,Papaioannou S,Kyriazopoulos K,Pylarinou V,Kontonassakis I,Kotakos C,Kourgiannidis G,Ntoliou P,Parzakonis N,Pipertzi A,Sakalidis A,Ververeli C-L,Kafkala K,Sinanis T,Diakakis G,Grammatikopoulos K,Papoutsaki E,Patialiatos T,Mamaloukaki M,Papadaki S T,Kanellos I E,Antoniou A,Tsinopoulos G,Goudis C,Giannadaki M,Daios S,Petridou M,Skantzis P,Koukis P,Dimitriadis F,Savvidis M,Styliadis I,Sachpekidis V,Pilalidou A,Stamatiadis N,Fotoglidis A,Karakanas A,Ruzsa Z,Becker D,Nowotta F,Gudmundsdottir I,Libungan B,Skuladottir F Bjork,Halldorsdottir H,Shetty R,Iyengar S,Bs C,G S,Lakshmana S,S R,Tripathy N,Sinha A,Choudhary B,Kumar A,Kumar A,Raj R,Roy R Sagar,Dharma S,Siswanto B B,Farhan H Ali,Yaseen I F,Al-Zaidi M,Dakhil Z,Amen S,Rasool B,Rajeeb A,Amber K,Ali H Hameed,Al-Kinani T,Almyahi M Hashim,Al-Obaidi F,Masoumi G,Sadeghi M,Heshmat-Ghahdarijani K,Roohafza H,Sarrafzadegan N,Shafeie M,Teimouri-Jervekani Z,Noori F,Kyavar M,Sadeghipour P,Firouzi A,Alemzadeh-Ansari M J,Ghadrdoost B,Golpira R,Ghorbani A,Ahangari F,Salarifar M,Jenab Y,Biria A,Haghighi S,Mansouri P,Yadangi S,Kornowski R,Orvin K,Eisen A,Oginetz N,Vizel R,Kfir H,Pasquale G Di,Casella G,Cardelli L S,Filippini E,Zagnoni S,Donazzan L,Ermacora D,Indolfi C,Polimeni A,Curcio A,Mongiardo A,De Rosa S,Sorrentino S,Spaccarotella C,Landolina M,Marino M,Cacucci M,Vailati L,Bernabò P,Montisci R,Meloni L,Marchetti M F,Biddau M,Garau E,Barbato E,Morisco C,Strisciuglio T,Canciello G,Lorenzoni G,Casu G,Merella P,Novo G,D'Agostino A,Lisi D Di,Palermo A Di,Evola S,Immordino F,Rossetto L,Spica G,Pavan D,Mattia A Della,Belfiore R,Grandis U,Vendrametto F,Spagnolo C,Carniel L,Sonego E,Gaudio C,Barillà F,Biccire F G,Bruno N,Ferrari I,Paravati V,Torromeo C,Galasso G,Peluso A,Prota C,Radano I,Benvenga R M,Ferraioli D,Anselmi M,Frigo G M,Sinagra G,Merlo M,Perkan A,Ramani F,Altinier A,Fabris E,Rinaldi M,Usmiani T,Checco L,Frea S,Mussida M,Matsukawa R,Sugi K,Kitai T,Furukawa Y,Masumoto A,Miyoshi Y,Nishino S,Assembekov B,Amirov B,Chernokurova Y,Ibragimova F,Mirrakhimov E,Ibraimova A,Murataliev T,Radzhapova Z,Uulu E Sultan,Zhanyshbekova N,Zventsova V,Erglis A,Bondare L,Zaliunas R,Gustiene O,Dirsiene R,Marcinkeviciene J,Sakalyte G,Virbickiene A,Baksyte G,Bardauskiene L,Gelmaniene R,Salkauskaite A,Ziubryte G,Kupstyte-Kristapone N,Badariene J,Balciute S,Kapleriene L,Lizaitis M,Marinskiene J,Navickaite A,Pilkiene A,Ramanauskaite D,Serpytis R,Silinskiene D,Simbelyte T,Staigyte J,Philippe F,Degrell P,Camus E,Ahmad W A Wan,Kassim Z Abu,Xuereb R G,Buttigieg L-L,Camilleri W,Pllaha E,Xuereb S,Popovici M,Ivanov V,Plugaru A,Moscalu V,Popovici I,Abras M,Ciobanu L,Litvinenco N,Fuior S,Dumanschi C,Ivanov M,Danila T,Grib L,Filimon S,Cardaniuc L,Batrinac A,Tasnic M,Cozma C,Revenco V,Sorici G,Dagva M,Choijiljav G,Dandar E,Khurelbaatar M-U,Tsognemekh B,Appelman Y,Den Hartog A,Kolste H Jan Te,Van Den Buijs D,Van'T Hof A,Pustjens T,Houben V,Kasperski I,Ten Berg J,Azzahhafi J,Bor W,Yin D Chan Pin,Mbakwem A,Amadi C,Kushimo O,Kilasho M,Oronsaye E,Bakracheski N,Bashuroska E Kovacheska,Mojsovska V,Tupare S,Dejan M,Jovanoska J,Razmoski D,Marinoski T,Antovski A,Jovanovski Z,Kocho S,Markovski R,Ristovski V,Samir A B,Biserka S,Kalpak O,Peovska I Mitevska,Taleska B Zafirovska,Pejkov H,Busljetik O,Zimbakov Z,Grueva E,Bojovski I,Tutic M,Poposka L,Vavlukis M,Al-Riyami A,Nadar S K,Abdelmottaleb W,Ahmed S,Mujtaba M Shaikh,Al-Mashari S,Al-Riyami H,Laghari A H,Faheem O,Ahmed S Waqar,Qamar N,Furnaz S,Kazmi K,Saghir T,Aneel A,Asim A,Madiha F,Sobkowicz B,Tycinska A,Kazimierczyk E,Szyszkowska A,Mizia-Stec K,Wybraniec M,Bednarek A,Glowacki K,Prokopczuk J,Babinski W,Blachut A,Kosiak M,Kusinska A,Samborski S,Stachura J,Szastok H,Wester A,Bartoszewska D,Sosnowska-Pasiarska B,Krzysiek M,Legutko J,Nawrotek B,Kasprzak J D,Klosinska M,Wiklo K,Kurpesa M,Rechcinski T,Cieslik-Guerra U,Gierlotka M,Bugajski J,Feusette P,Sacha J,Przybylo P,Krzesinski P,Ryczek R,Karasek A,Kazmierczak-Dziuk A,Mielniczuk M,Betkier-Lipinska K,Roik M,Labyk A,Krakowian M,Machowski M,Paczynska M,Potepa M,Pruszczyk P,Budaj A,Ambroziak M,Omelanczuk-Wiech E,Torun A,Opolski G,Glowczynska R,Fojt A,Kowalik R,Huczek Z,Jedrzejczyk S,Roleder T,Brust K,Gasior M,Desperak P,Hawranek M,Farto-Abreu P,Santos M,Baptista S,Brizida L,Faria D,Loureiro J,Magno P,Monteiro C,Nédio M,Tavares J,Sousa C,Almeida I,Almeida S,Miranda H,Santos H,Santos A P,Goncalves L,Monteiro S,Baptista R,Ferreira C,Ferreira J,Goncalves F,Lourenço C,Monteiro P,Picarra B,Santos A R,Guerreiro R Azevedo,Carias M,Carrington M,Pais J,de Figueiredo M Paralta,Rocha A R,Mimoso J,De Jesus I,Fernandes R,Guedes J,Mota T,Mendes M,Ferreira J,Tralhão A,Aguiar C Tavares,Strong C,Da Gama F Fernandes,Pais G,Timóteo A T,Rosa S Aguiar Oliveira,Mano T,Reis J,Selas M,Mendes D Espregueira,Satendra M,Pinto P,Queirós C,Oliveira I,Reis L,Cruz I,Fernandes R,Torres S,Luz A,Campinas A,Costa R,Frias A,Oliveira M,Martins V,Castilho B,Coelho 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L,Pisaryuk A,Potapov P,Teterina M,Ageev F,Silvestrova G,Fedulaev Y,Pinchuk T,Staroverov I,Kalimullin D,Sukhinina T,Zhukova N,Ryabov V,Kruchinkina E,Vorobeva D,Shevchenko I,Budyak V,Elistratova O,Fetisova E,Islamov R,Ponomareva E,Khalaf H,Shaimaa A Al,Kamal W,Alrahimi J,Elshiekh A,Balghith M,Ahmed A,Attia N,Jamiel A A,Potpara T,Marinkovic M,Mihajlovic M,Mujovic N,Kocijancic A,Mijatovic Z,Radovanovic M,Matic D,Milosevic A,Savic L,Subotic I,Uscumlic A,Zlatic N,Antonijevic J,Vesic O,Vucic R,Martinovic S Salinger,Kostic T,Atanaskovic V,Mitic V,Stanojevic D,Petrovic M,Kovacevic M,Crnomarkovic B,Cankovic M,Dabovic D,Jarakovic M,Pantic T,Trajkovic M,Pupic L,Ruzicic D,Cvetanovic D,Obradovic I,Stankovic M,Loh P H,Kong W,Poh K-K,Sia C-H,Saw K,Liška D,Brozmannová D,Gbur M,Maxian R,Kovacic D,Poznic N Glavnik,Keric T,Kotnik G,Cercek M,Steblovnik K,Sustersic M,Cercek A Cerne,Djokic I,Drnovsek B,Lipar L,Mocilnik M,Pleskovic A,Lainscak M,Crncic D,Nikojajevic I,Tibaut M,Cigut M,Leskovar B,Furlan T,Grilj 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Affiliation:

1. Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 3AA, Leeds , UK

2. Leeds Institute of Data Analytics, University of Leeds, LS2 9NL, Leeds , UK

3. Department of Cardiology, Leeds Teaching Hospitals NHS Trust , Leeds , UK

4. Institute of Cardiovascular Sciences, University of Birmingham , Birmingham , UK

5. EURObservational Research Programme, European Society of Cardiology, European Heart House , Route des Colles, Sophia Antipolis, 2035 , France

6. Department of Cardiology, Amsterdam UMC-Vrije Universiteit, Amsterdam Cardiovascular Sciences , Amsterdam , The Netherlands

7. Hospital Clinic de Barcelona , Barcelona , Spain

8. Institut d'Investigacions Biomèdiques August Pi i Sunyer , Barcelona , Spain

9. Department of Cardiology, Center of Postgraduate Medical Education, Grochowski Hospital , Warsaw , Poland

10. Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12) , Madrid , Spain

11. Centro Nacional de Investigaciones Cardiovasculares (CNIC) , Madrid , Spain

12. Facultad de Medicina, Universidad Complutense de Madrid , Madrid , Spain

13. 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital) , Vienna , Austria

14. Sigmund Freud University, Medical Faculty , Vienna , Austria

15. Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University , Newcastle upon Tyne , UK

16. Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK

17. University of Pavia , Pavia , Italy

18. Fondazione IRCCS Policlinico S.Matteo , Pavia , Italy

19. Cardio-Thoracic and Vascular Department, San Gerardo Hospital , ASST-Monza, Monza , Italy

20. Department of Cardiology, University Clinical Center of Serbia and Faculty of Medicine, University of Begrade , Belgrade , Serbia

Abstract

Abstract Background The majority of NSTEMI burden resides outside high-income countries (HICs). We describe presentation, care, and outcomes of NSTEMI by country income classification. Methods and results Prospective cohort study including 2947 patients with NSTEMI from 287 centres in 59 countries, stratified by World Bank country income classification. Quality of care was evaluated based on 12 guideline-recommended care interventions. The all-or-none scoring composite performance measure was used to define receipt of optimal care. Outcomes included in-hospital acute heart failure, stroke/transient ischaemic attack, and death, and 30-day mortality. Patients admitted with NSTEMI in low to lower-middle-income countries (LLMICs), compared with patients in HICs, were younger, more commonly diabetic, and current smokers, but with a lower burden of other comorbidities, and 76.7% met very high risk criteria for an immediate invasive strategy. Invasive coronary angiography use increased with ascending income classification (LLMICs, 79.2%; upper middle income countries [UMICs], 83.7%; HICs, 91.0%), but overall care quality did not (≥80% of eligible interventions achieved: LLMICS, 64.8%; UMICs 69.6%; HICs 55.1%). Rates of acute heart failure (LLMICS, 21.3%; UMICs, 12.1%; HICs, 6.8%; P < 0.001), stroke/transient ischaemic attack (LLMICS: 2.5%; UMICs: 1.5%; HICs: 0.9%; P = 0.04), in-hospital mortality (LLMICS, 3.6%; UMICs: 2.8%; HICs: 1.0%; P < 0.001) and 30-day mortality (LLMICs, 4.9%; UMICs, 3.9%; HICs, 1.5%; P < 0.001) exhibited an inverse economic gradient. Conclusion Patients with NSTEMI in LLMICs present with fewer comorbidities but a more advanced stage of acute disease, and have worse outcomes compared with HICs. A cardiovascular health narrative is needed to address this inequity across economic boundaries.

Funder

Abbott Vascular

Amgen

AstraZeneca

Bayer AG

Boehringer Ingelheim

Boston Scientific

Bristol Myers Squibb

Pfizer

Daiichi Sankyo Company

Eli Lilly and Company

Edwards