Abstract 37: Long-term Outcomes Of Patients With ST-Elevation Myocardial Infarction (STEMI) With And Without Reperfusion Therapy: Results Of A Systematic Province-wide Field Evaluation In Quebec
Notice bibliographique
Résumé
BACKGROUND: Reperfusion treatment of patients with ST-Elevation Myocardial Infarction (STEMI) reduces short-term morbidity and mortality. There is little real-world data on longer-term benefits. Our province-wide field evaluation of STEMI care linked process-of-care data to Quebec’s medico-administrative data to determine clinical outcomes at 3 years. METHODS: Medical charts of patients with a final diagnosis of myocardial infarction who presented with acute symptoms to one of 80 Quebec hospitals (that treat over 95% of such patients) were reviewed. STEMI was confirmed by core laboratory analysis of the presenting electrocardiogram. Patient characteristics, process-of-care data and treatment delays were entered in a centralized website. Patients who were not sent for primary angioplasty or did not receive fibrinolysis within 4 hours of presentation were classified as having no reperfusion treatment. Treated patients were classified according to guidelines, as having timely or untimely reperfusion therapy. For follow-up to 3 years, medical insurance numbers were linked to medico-administrative data recording hospitalisations, revascularization procedures and deaths. RESULTS: We identified 2035 patients with STEMI or left bundle branch block during a 6 month period (2006-7). Of these, 23% (n=469) were classified as not having received reperfusion treatment. Of the remaining 1566 patients, 564 had timely treatment and 891 had delays beyond the recommended maximum. Timeliness could not be classified for 111 patients who were sent for primary angioplasty but did not undergo device deployment. At 3 years follow-up, 39% (184/469) of patients without reperfusion treatment had died compared to 12% (190/1566) of patients with reperfusion treatment (RR=3.23; 95% CI=2.72-3.85). Patients without reperfusion treatment were also more likely than treated patients to be hospitalized for heart failure (13.2% vs 4.4%; RR=3.00; 95% CI=2.16-4.16) and reinfarction (7.2% vs 4.9%; RR=1.47; 95% CI=1.00-2.18). Of patients who received reperfusion treatment beyond maximum recommended delays, 14.4% (n=128/891) died within 3 years, compared to 6.9% (n=39/564) of those who received timely treatment (RR=2.26, 95% CI=1.25-3.02). Patients with untimely treatment were more likely than those with timely treatment to be hospitalized for heart failure (5.5% vs 2.3% ; RR=2.47; 95% CI=1.33-4.56) but their risk of readmission for myocardial infarction was similar (5.3% vs 4.1%; RR=1.31; 95% CI=0.79-2.18). After adjustment for demographic and clinical factors, the risk ratios for 3-year mortality associated with non-receipt of reperfusion therapy and untimely reperfusion therapy relative to timely reperfusion were 2.38 (95% CI=1.59-3.56) and 1.61 (95% CI=1.12-2.32), respectively. CONCLUSIONS: This systematic evaluation of STEMI care with long-term follow-up indicates that reperfusion treatment is associated with improved clinical outcomes at 3 years. Greater benefit was observed in patients who had reperfusion therapy within guideline-recommended delays. These results emphasize the importance of increasing the use of reperfusion therapy and decreasing treatment delays.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,007 | 0,013 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,002 |
| Bibliométrie | 0,003 | 0,006 |
| Études des sciences et des technologies | 0,002 | 0,001 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».