RT Journal Article
T1 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
A1 Nadarajah, Ramesh
A1 Ludman, Peter
A1 Laroche, Cécile
A1 Appelman, Yolande
A1 Brugaletta, Salvatore
A1 Budaj, Andrzej
A1 Bueno, Héctor
A1 Huber, Kurt
A1 Kunadian, Vijay
A1 Leonardi, Sergio
A1 Lettino, Maddalena
A1 Milasinovic, Dejan
A1 Gale, Chris P.
A1 Moreno Muñoz, Guillermo
A1 NSTEMI (grupo de investigación), 
AB 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.
PB Oxford Academic
SN 2058-5225
SN 2058-1742
YR 2023
FD 2023-02-03
LK https://hdl.handle.net/20.500.14352/109752
UL https://hdl.handle.net/20.500.14352/109752
LA eng
NO Nadarajah R, Ludman P, Laroche C, Appelman Y, Brugaletta S, Budaj A, et al. 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. European Heart Journal - Quality of Care and Clinical Outcomes. 2023;9(6):552-63.
NO Abbott Vascular Int
NO Amgen Cardiovascular
NO AstraZeneca
NO Bayer AG
NO Boehringer Ingelheim
NO Boston Scientific
NO the Bristol Myers Squibb and Pfizer Alliance
NO Daiichi Sankyo Europe GmbH
NO the Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company
NO Edwards
NO Gedeon Richter Plc
NO Menarini Int. Op
NO MSD-Merck & Co
NO Novartis Pharma AG
NO ResMed
NO Sanofi
NO Servier
NO Vifor
DS Docta Complutense
RD 4 abr 2025