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Sex differences in hospital mortality following acute myocardial infarction in China: findings from a study of 45?852 patients in the COMMIT/CCS-2 study.

ABSTRACT: OBJECTIVE:To assess the sex difference in hospital mortality following ST elevation myocardial infarction (STEMI) in China. DESIGN:Observational study of patients enrolled into a large trial, adjusting for age, presenting characteristics and hospital treatments using logistic regression. SETTINGS:1250 hospitals in China during 1999-2005. PATIENTS:42?683 STEMI patients, including 31?309 men and 11?374 women. INTERVENTION:In the original trial, all patients received 162?mg of aspirin plus 75?mg of clopidogrel daily or matching placebo and metoprolol (15?mg intravenous then 200?mg oral daily) or matching placebo. All other aspects of patients' treatments were at the discretion of responsible doctors. MAJOR OUTCOMES:Hospital mortality from any cause during the scheduled trial treatment period (ie, up to 4?weeks in hospital). RESULTS:Overall, 8% of the patients died in hospital, with the crude hospital mortality being twice as high in women as in men (12.6% vs 6.3%). After adjusting for age, the sex difference in hospital mortality attenuated but remained highly significant (OR 1.54; 95% CI 1.43 to 1.66). Further adjustment for other baseline characteristics and for the treatments given in hospital had little effect on the sex difference in hospital mortality (OR 1.50, 95% CI 1.38 to 1.62). The difference in hospital mortality was greater at a younger age, with the adjusted ORs being 2.14, 1.70, 1.48 and 1.18, respectively, for ages <55, 55-64, 65-74 and ?75?years (p=0.0001 for trend). CONCLUSION:Compared with men of the same age, women had approximately a 50% higher mortality following hospital admission for STEMI, with a particularly higher excess risk at age <55?years.

SUBMITTER: Chen Y

PROVIDER: S-EPMC4898572 | biostudies-literature | 2011

REPOSITORIES: biostudies-literature

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Sex differences in hospital mortality following acute myocardial infarction in China: findings from a study of 45 852 patients in the COMMIT/CCS-2 study.

Chen Yiping Y Jiang Lixin L Smith Margaret M Pan Hongchao H Collins Rory R Peto Richard R Chen Zhengming Z

Heart Asia 20110101 1

<h4>Objective</h4>To assess the sex difference in hospital mortality following ST elevation myocardial infarction (STEMI) in China.<h4>Design</h4>Observational study of patients enrolled into a large trial, adjusting for age, presenting characteristics and hospital treatments using logistic regression.<h4>Settings</h4>1250 hospitals in China during 1999-2005.<h4>Patients</h4>42 683 STEMI patients, including 31 309 men and 11 374 women.<h4>Intervention</h4>In the original trial, all patients rece ...[more]

PMID: 27326005

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Project description:BackgroundMachine learning (ML) risk prediction models, although much more accurate than traditional statistical methods, are inconvenient to use in clinical practice due to their nontransparency and requirement of a large number of input variables.ObjectiveWe aimed to develop a precise, explainable, and flexible ML model to predict the risk of in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI).MethodsThis study recruited 18,744 patients enrolled in the 2013 China Acute Myocardial Infarction (CAMI) registry and 12,018 patients from the China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE)-Retrospective Acute Myocardial Infarction Study. The Extreme Gradient Boosting (XGBoost) model was derived from 9616 patients in the CAMI registry (2014, 89 variables) with 5-fold cross-validation and validated on both the 9125 patients in the CAMI registry (89 variables) and the independent China PEACE cohort (10 variables). The Shapley Additive Explanations (SHAP) approach was employed to interpret the complex relationships embedded in the proposed model.ResultsIn the XGBoost model for predicting all-cause in-hospital mortality, the variables with the top 8 most important scores were age, left ventricular ejection fraction, Killip class, heart rate, creatinine, blood glucose, white blood cell count, and use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs). The area under the curve (AUC) on the CAMI validation set was 0.896 (95% CI 0.884-0.909), significantly higher than the previous models. The AUC for the Global Registry of Acute Coronary Events (GRACE) model was 0.809 (95% CI 0.790-0.828), and for the TIMI model, it was 0.782 (95% CI 0.763-0.800). Despite the China PEACE validation set only having 10 available variables, the AUC reached 0.840 (0.829-0.852), showing a substantial improvement to the GRACE (0.762, 95% CI 0.748-0.776) and TIMI (0.789, 95% CI 0.776-0.803) scores. Several novel and nonlinear relationships were discovered between patients' characteristics and in-hospital mortality, including a U-shape pattern of high-density lipoprotein cholesterol (HDL-C).ConclusionsThe proposed ML risk prediction model was highly accurate in predicting in-hospital mortality. Its flexible and explainable characteristics make the model convenient to use in clinical practice and could help guide patient management.Trial registrationClinicalTrials.gov NCT01874691; https://clinicaltrials.gov/study/NCT01874691.

Project description:Thirty-day risk-standardized mortality rates after acute myocardial infarction are commonly used to evaluate and compare hospital performance. However, it is not known whether differences among hospitals in the early survival of patients with acute myocardial infarction are associated with differences in long-term survival.We analyzed data from the Cooperative Cardiovascular Project, a study of Medicare beneficiaries who were hospitalized for acute myocardial infarction between 1994 and 1996 and who had 17 years of follow-up. We grouped hospitals into five strata that were based on case-mix severity. Within each case-mix stratum, we compared life expectancy among patients admitted to high-performing hospitals with life expectancy among patients admitted to low-performing hospitals. Hospital performance was defined by quintiles of 30-day risk-standardized mortality rates. Cox proportional-hazards models were used to calculate life expectancy.The study sample included 119,735 patients with acute myocardial infarction who were admitted to 1824 hospitals. Within each case-mix stratum, survival curves of the patients admitted to hospitals in each risk-standardized mortality rate quintile separated within the first 30 days and then remained parallel over 17 years of follow-up. Estimated life expectancy declined as hospital risk-standardized mortality rate quintile increased. On average, patients treated at high-performing hospitals lived between 0.74 and 1.14 years longer, depending on hospital case mix, than patients treated at low-performing hospitals. When 30-day survivors were examined separately, there was no significant difference in unadjusted or adjusted life expectancy across hospital risk-standardized mortality rate quintiles.In this study, patients admitted to high-performing hospitals after acute myocardial infarction had longer life expectancies than patients treated in low-performing hospitals. This survival benefit occurred in the first 30 days and persisted over the long term. (Funded by the National Heart, Lung, and Blood Institute and the National Institute of General Medical Sciences Medical Scientist Training Program.).

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Sex differences in hospital mortality following acute myocardial infarction in China: findings from a study of 45?852 patients in the COMMIT/CCS-2 study.

Publications

Sex differences in hospital mortality following acute myocardial infarction in China: findings from a study of 45 852 patients in the COMMIT/CCS-2 study.

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