Hospital Mortality from Myocardial Infarction in Latin America and the Caribbean: Systematic Review and Meta-Analysis
Leonardo Alves1,2, Patrícia K Ziegelmann1, Victor Ribeiro2
1Programa de Pós-Graduação em Cardiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil.
Insights
In-hospital mortality for ST-elevation myocardial infarction (STEMI) in Latin America was 9.9%, with higher rates linked to less reperfusion therapy. Non-ST-elevation myocardial infarction (NSTEMI) mortality was 6.3%.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Cardiovascular diseases are a leading cause of death globally, particularly in low- and middle-income countries.
- Myocardial infarction (MI) represents a significant life-threatening condition within cardiovascular diseases.
- This study focuses on in-hospital mortality for ST-elevation MI (STEMI) and non-ST-elevation MI (NSTEMI) in Latin America and the Caribbean.
Approach:
- A systematic literature search was conducted in electronic bibliographic databases.
- Meta-analysis of cohort studies reporting in-hospital mortality for STEMI and NSTEMI from 2000 onwards.
- Statistical significance was determined using a p-value < 0.05.
Key Points:
- Pooled in-hospital mortality for STEMI was 9.9% (95% CI: 9.1 - 10.7), with significant heterogeneity.
- Higher rates of reperfusion therapy correlated with lower STEMI in-hospital mortality (p<0.001).
- STEMI mortality was higher in the first decade (2000s) compared to the second (p=0.047).
- Pooled in-hospital mortality for NSTEMI was 6.3% (95% CI: 5.4 - 7.4) with no significant heterogeneity.
Conclusions:
- STEMI in-hospital mortality in Latin America and the Caribbean is high compared to high-income countries.
- Increased use of reperfusion therapy is crucial for improving STEMI outcomes.
- NSTEMI in-hospital mortality was comparable to high-income countries, though based on limited data from few countries.
Background:
Most cardiovascular deaths occur in low- and middle-income countries and myocardial infarction is one of the main life-threatening conditions.
Objective:
We assessed all-cause in-hospital mortality in patients admitted for myocardial infarction (STEMI and NSTEMI) in Latin America and the Caribbean from 2000 onward.
Methods:
We systematically searched in electronic bibliographic databases for cohort studies which reported in-hospital mortality due to STEMI and NSTEMI. A meta-analysis was performed and a p-value < 0.05 was considered significant.
Results:
We identified 38 studies (29 STEMI, 3 NSTEMI and 6 both). Pooled STEMI in-hospital mortality was 9.9% (95% CI: 9.1 - 10.7). Heterogeneity was not trivial (I2 = 74% and prediction interval = 6.6 - 14.5). The percentage of reperfusion therapy and decade explain part of the heterogeneity (I2 = 54%). The higher the rate of reperfusion therapy, the lower the in-hospital mortality (coefficient = -0.009, 95% CI: -0.013 to -0.006, p<0.001). This mortality was higher in the first decade as compared with the second (coefficient = -0.14, 95% CI: -0.27 to -0.02, p=0.047). Pooled NSTEMI in-hospital mortality was 6.3% (95% CI: 5.4 - 7.4) and heterogeneity was null.
Conclusion:
Pooled STEMI in-hospital mortality in low- and middle-income countries was high in comparison with rates reported in high income countries. To improve these estimates, higher use of reperfusion therapy must be pursued. Pooled NSTEMI in-hospital mortality was similar to the ones found in high-income countries; however, it was based on few studies and most of them were carried out in two countries.
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