Cardiac procedures in ST-segment-elevation myocardial infarction - the influence of age, geography and Aboriginality

Autor: Judy A. Trevena, Kerry Chant, Lee Taylor, S.C. Faddy, Marianne Gale, Paul Kelly, Scott F Winch, Michael Nelson, Hai Phung, David Brieger, Leah A. Newman, Michelle Cretikos
Rok vydání: 2020
Předmět:
Male
lcsh:Diseases of the circulatory (Cardiovascular) system
Native Hawaiian or Other Pacific Islander
Australian Capital Territory
Databases
Factual
medicine.medical_treatment
030204 cardiovascular system & hematology
Coronary Angiography
Percutaneous coronary intervention
0302 clinical medicine
Residence Characteristics
Risk Factors
Medicine
ST segment
030212 general & internal medicine
Myocardial infarction
Coronary Artery Bypass
education.field_of_study
medicine.diagnostic_test
Age Factors
Angiography
Middle Aged
Race Factors
Cardiac surgery
Treatment Outcome
surgical procedures
operative
Female
New South Wales
Cardiology and Cardiovascular Medicine
Research Article
Cohort study
Adult
medicine.medical_specialty
Population
ST-segment elevation myocardial infarction (STEMI)
Time-to-Treatment
03 medical and health sciences
Humans
cardiovascular diseases
Healthcare Disparities
education
Aged
business.industry
medicine.disease
lcsh:RC666-701
Conventional PCI
Emergency medicine
ST Elevation Myocardial Infarction
business
Zdroj: BMC Cardiovascular Disorders
BMC Cardiovascular Disorders, Vol 20, Iss 1, Pp 1-9 (2020)
ISSN: 1471-2261
Popis: Background Timely restoration of bloodflow acute ST-segment elevation myocardial infarction (STEMI) reduces myocardial damage and improves prognosis. The objective of this study was describe the association of demographic factors with hospitalisation rates for STEMI and time to angiography, Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Graft (CABG) in New South Wales (NSW) and the Australian Capital Territory (ACT), Australia. Methods This was an observational cohort study using linked population health data. We used linked records of NSW and the ACT hospitalisations and the Australian Government Medicare Benefits Schedule (MBS) for persons aged 35 and over hospitalised with STEMI in the period 1 July 2010 to 30 June 2014. Survival analysis was used to determine the time between STEMI admission and angiography, PCI and CABG, with a competing risk of death without cardiac procedure. Results Of 13,117 STEMI hospitalisations, 71% were among males; 55% were 65-plus years; 64% lived in major cities, and 2.6% were Aboriginal people. STEMI hospitalisation occurred at a younger age in males than females. Angiography and PCI rates decreased with age: angiography 69% vs 42% and PCI 60% vs 34% on day 0 for ages 35-44 and 75-plus respectively. Lower angiography and PCI rates and higher CABG rates were observed outside major cities. Aboriginal people with STEMI were younger and more likely to live outside a major city. Angiography, PCI and CABG rates were similar for Aboriginal and non-Aboriginal people of the same age and remoteness area. Conclusions There is a need to improve access to definitive revascularisation for STEMI among appropriately selected older patients and in regional areas. Aboriginal people with STEMI, as a population, are disproportionately affected by access to definitive revascularisation outside major cities. Improving access to timely definitive revascularisation in regional areas may assist in closing the gap in cardiovascular outcomes between Aboriginal and non-Aboriginal people.
Databáze: OpenAIRE
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