Abstract
Background
Little is known about temporal trends in the prevalence of cardiovascular and non-cardiovascular comorbidities in patients presenting with acute myocardial infarction (AMI).
...Methods
AMIS Plus registry patients enrolled between 2004 and 2021 were stratified based on comorbidities in 3 groups: (1) «cardiovascular comorbidity»: at least one among past history of myocardial infarction, coronary artery bypass grafting or percutaneous coronary intervention, heart failure, peripheral vascular disease, cerebrovascular disease, or atrial fibrillation; (2) «non-cardiovascular comorbidity»: at least one among dementia, chronic lung disease, connective tissue disease, peptic ulcer disease, moderate or severe renal disease, diabetes, liver disease, or cancer disease; and (3) «any comorbidity»: at least one of the mentioned comorbidities. Prevalence and mortality were analysed according to the type of comorbidity in 2-year periods and stratified by sex. Temporal trends were analysed using the Mantel-Haenszel linear-by-linear association Chi-squared test.
Results
Among the 48’848 patients enrolled, 24’215 (49.6%) had at least one comorbidity. Of these, 17’441 (72.0%) were male and 6’774 (28.0%) female. Over the years, there was a significant decrease in the prevalence of «any comorbidity» (p<0.001) as well as «cardiovascular comorbidity» (p<0.001). A significant decrease in the prevalence of «any comorbidity» as well as «cardiovascular comorbidity» was detected for both sexes. With respect to the prevalence of «non-cardiovascular comorbidity», a significant reduction over time was observed in men but not in women. The reduction of in-hospital mortality over time was significant across all groups, overall and for both sexes individually.
Conclusions
Over more than a decade, a significant reduction in the prevalence of comorbidities was observed in patients presenting with AMI, with the exception of non-cardiovascular comorbidities in women. This reduction may have contributed, in addition to the improvements in pharmacologic treatments as well as in revascularization, to the improved survival observed over time.Temporal trends of comorbidities
Abstract
Introduction
We previously described sex differences in baseline characteristics, interventional therapy and mortality in patients admitted for acute coronary syndromes (ASC) in Swiss ...hospitals and enrolled in the AMIS Plus registry between 1997 and 2006 (1). This present analysis aimed to reassess whether anything changed over the last 15 years.
Method
All AMIS Plus patients enrolled between 2007 and 2021 were included. Baseline characteristics, therapy and outcome were analysed according to sex and age groups. Multivariate analyses were performed to assess independent predictors of in-hospital mortality.
Results
Among 42,471 patients, 10,825 (25.5%) were women. Women were still older (71.6±12.6y vs. 64.2±12.6y for men), had more comorbidities (Charlson Comorbidity Index>1: 26.5% vs. 21.7%), were less likely to receive drug therapy (e.g., P2Y12 inhibitors 83.3% vs. 89.2% or statins 73.0% vs. 78.5%) and underwent percutaneous coronary intervention (PCI) less frequently (OR 0.77; 95% CI 0.73–0.83). These findings paralleled our observations for the period 1997–2006. However, the increase in PCI use over the years, particularly in women, led to a marked decrease in differences between men and women with respect to revascularization, from 16.6% in 2006 down to 2.0% in 2020. Unadjusted in-hospital mortality was higher in women (OR 1.55; 95% CI 1.41–1.70), but this significance disappeared after adjustment for baseline differences (OR 1.07; (95% CI 0.96–1.20)). However, in women under the age of 50 years, crude mortality (3.1% versus 1.6%) was significantly higher than in same-aged men; adjusted OR 1.78 (95% CI 0.99–3.20).
Conclusions
Sex differences in the baseline characteristics of ACS patients and the use of evidence-based drugs persisted but the sex gap in PCI access slowly but surely diminished. Female sex per se was not an independent predictor of in-hospital mortality in the overall population but it showed a strong trend among patients younger than 50 years of age.
Funding Acknowledgement
Type of funding sources: None.
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