Use of relative survival to evaluate non-ST-elevation myocardial infarction quality of care and clinical outcomes
Use of relative survival to evaluate non-ST-elevation myocardial infarction quality of care and clinical outcomes
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DOI：
10.1093/ehjqcco/qcv011
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发表时间：
2015-11-01
影响因子：
5.2
通讯作者：
Gale, Chris P.
中科院分区：
文献类型：
--
作者：
Hall, Marlous;Alabas, Oras A.;Gale, Chris P.
非st段抬高型心肌梗死（NSTEMI）后的生存率很高，非心血管死亡变得更加频繁。观察性研究通常使用全因死亡率来量化护理质量和临床结果，目前可能无法反映NSTEMI指数的影响。我们回顾和调查了量化NSTEMI后长期预后的相对生存率。住院NSTEMI的国家队列研究（心肌缺血国家审计项目；患者：n = 346 546，医院：n = 243，国家：英格兰和威尔士）。将两种相对生存技术得出的死亡率与全因死亡率进行比较，并将经相对生存调整的患者特征的影响与Cox比例估计值进行比较。Cox比例风险模型提供了较低的生存估计，因为它们包括了所有原因的死亡，高估了年龄增长对生存的影响，低估了护理的时间改善。Royston-Parmar模型可以更准确地估计相对生存率，因为它对住院NSTEMI后较高的早期死亡风险具有灵活性。全因死亡率是对一组患者的总体生存评估。相对生存提供了一个更准确和知情的估计指数心血管事件的影响，如有必要，患者特征对生存的影响。
Survival after non-ST-elevation myocardial infarction (NSTEMI) is high and non-cardiovascular death has become more frequent. Observational studies typically quantify quality of care and clinical outcomes using all-cause mortality, which nowadays may not reflect the impact of index NSTEMI. We review and investigate relative survival for quantifying longer term outcomes after NSTEMI. National cohort study of hospitalized NSTEMI (Myocardial Ischaemia National Audit Project; patients: n = 346 546, hospitals: n = 243, countries: England and Wales). Mortality rates derived from two relative survival techniques were compared with all-cause mortality, and the impact of relative survival adjusted patient characteristics compared with those from Cox proportional estimates. Cox proportional hazards models provide lower survival estimates because they include deaths from all causes, overestimate the impact of increasing age on survival, and underestimate temporal improvements in care. The Royston-Parmar model allows more accurate estimation of relative survival because it is flexible to the high early hazard of death after hospitalized NSTEMI. All-cause mortality gives an overall assessment of survival for a cohort of patients. Relative survival provides a more accurate and informed estimation of the impact of an index cardiovascular event and, if necessary, patient characteristics on survival.