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Aims We investigated the implementation of new guidelines in ST-segment elevation myocardial infarction (STEMI) patients in a large real-world patient population in the metropolitan area of Berlin (Germany) over a 20-year period. Methods From January 2000 to December 2019, a total of 25 792 patients were admitted with STEMI to one of the 34 member hospitals of the Berlin-Brandenburg Myocardial Infarction Registry (B2HIR) and were stratified for sex and age Results The median age of women was 72 years (IQR 61–81) compared to 61 years in men (IQR 51–71). PCI treatment as a standard of care was implemented in men earlier than in women across all age groups. It took two years from the 2017 class IA ESC STEMI guideline recommendation to prefer the radial access route rather than femoral until > 60% of patients were treated accordingly. In 2019, less than 60% of elderly women were treated via a radial access. While the majority of patients p p p = 0.002), but not in patients p = 0.076). Conclusion In-hospital mortality differs considerably by age and sex and remains highest in elderly patients and in particular in elderly females. In these patient groups, guideline recommended therapies were implemented with a significant delay. Graphical abstract

This study investigates the changes in therapy for Non-ST-Elevation Myocardial Infarction (NSTEMI) over the past 16 years in a large German registry. In particular, the high-risk population of female and elderly patients was analyzed.In total, 19.383 patients presenting with NSTEMI were included in this study. Patients were stratified by age groups75 years and ≥75 years and by sex. Four different time periods from 2000-2004, 2005-2008, 2009-2012 and 2013-2016 were compared. Influence on hospital mortality as the primary outcome measure was assessed by logistic regression analysis. Secondary outcome measures included percutaneous coronary intervention (PCI), the use of drug eluting stents (DES), radial access route and major adverse cardiovascular events (MACE), defined as all-cause mortality, stroke, re-infarction, percutaneous re-intervention, intervention-related bleeding, cardiopulmonary resuscitation and new onset of cardiogenic shock or need for mechanical ventilation.Mortality decreased in all age groups between the initial time period and the most recent one (8.9% vs. 4.5%, p 0.01), particularly in female patients ≥75 years (18.2% in 2000-2004 vs. 7.9% in 2013-2016, p 0.01). Revascularization rates differed by gender (68.3% in women vs. 78.1% in men, p 0.01) and by age (64.2% for ≥75 years vs. 80.9% for75 years, p 0.01). PCI rates in elderly female patients increased from 28.7% to 69.8% (p 0.01) from the initial to the latest period.The present study demonstrates, that revascularization rates improved in all patient groups over the study period. However, females and elderly patients still remain less likely to be treated according to current guidelines.

Ziel der Studie Die Sterblichkeit am Herzinfarkt setzt sich zusammen aus den auserhalb und innerhalb der Klinik Verstorbenen. Da es sich beim Herzinfarkt um eine schwerwiegende Erkrankung handelt, ist der Anteil an Patienten, die vor Krankenhausaufnahme versterben, vergleichsweise gros und wie Daten aus Schweden und Augsburg zeigen in seiner relativen Haufigkeit bezogen auf alle am Infarkt Verstorbenen uber die Zeit ansteigend. Ziel unserer Studie war es, fur Berlin den Anteil an auserhalb zu innerhalb der Klinik am Infarkt Verstorbenen zu ermitteln. Methode Gemeinsam mit dem Berliner Zentralarchiv fur Leichenschauscheine wurden alle Leichenschauscheine vom 1.7.14–30.6.15 durchgesehen und die 1076 Verstorbenen, bei denen im Leichenschauschein Infarkt nach bestimmten Suchworten oder ICD10 kodiert (I21, I22, I23) angegeben wurde, anonymisiert in unsere Studie eingeschlossen. Ergebnis Von den 1076 identifizierten Patienten verstarben 66% auserhalb und 34% wahrend ihres Krankenhausaufenthaltes. Die innerhalb und auserhalb der Kliniken am Infarkt Verstorbenen zeigten keine Unterschiede im Anteil Frauen (40,4% innerhalb, 39,0% auserhalb; p=0,671), in der Haufigkeit der Obduktion (16,8–16,6%; p=0,938) oder in der Todesart „nicht naturlich“ bzw. ungewiss (17,1–19,3%; p=0,388). Unterschiede gab es im Alter und in den Sterbemonaten. Die auserhalb der Kliniken an einem Herzinfarkt Verstorbenen waren vergleichsweise junger (76J.) als die in den Kliniken Verstorbenen (80J.). Dabei ist die Differenz am grosten bei den

Die Sterblichkeit am Herzinfarkt setzt sich zusammen aus den außerhalb und innerhalb der Klinik Verstorbenen. Da es sich beim Herzinfarkt um eine schwerwiegende Erkrankung handelt, ist der Anteil an Patienten, die vor Krankenhausaufnahme versterben, vergleichsweise groß und wie Daten aus Schweden und Augsburg zeigen in seiner relativen Häufigkeit bezogen auf alle am Infarkt Verstorbenen über die Zeit ansteigend. Ziel unserer Studie war es, für Berlin den Anteil an außerhalb zu innerhalb der Klinik am Infarkt Verstorbenen zu ermitteln.Gemeinsam mit dem Berliner Zentralarchiv für Leichenschauscheine wurden alle Leichenschauscheine vom 1.7.14–30.6.15 durchgesehen und die 1076 Verstorbenen, bei denen im Leichenschauschein Infarkt nach bestimmten Suchworten oder ICD10 kodiert (I21, I22, I23) angegeben wurde, anonymisiert in unsere Studie eingeschlossen.Von den 1076 identifizierten Patienten verstarben 66% außerhalb und 34% während ihres Krankenhausaufenthaltes. Die innerhalb und außerhalb der Kliniken am Infarkt Verstorbenen zeigten keine Unterschiede im Anteil Frauen (40,4% innerhalb, 39,0% außerhalb; p=0,671), in der Häufigkeit der Obduktion (16,8–16,6%; p=0,938) oder in der Todesart „nicht natürlich“ bzw. ungewiss (17,1–19,3%; p=0,388). Unterschiede gab es im Alter und in den Sterbemonaten. Die außerhalb der Kliniken an einem Herzinfarkt Verstorbenen waren vergleichsweise jünger (76J.) als die in den Kliniken Verstorbenen (80J.). Dabei ist die Differenz am größten bei den65-Jährigen, die zu 76,3% außerhalb und zu 23,7% in der Klinik verstarben. In den Monaten Juli–September war der relative Anteil an außerhalb der Klinik Verstorbenen mit 15,4% am niedrigsten und mit 29,4% für die innerhalb der Klinik Verstorbenen am höchsten. Diese Tendenz traf auf jüngere und ältere Verstorbene und auf Männer und Frauen gleichermaßen zu.Im Untersuchungszeitraum Juli 2014 bis Juni 2015 verstarben zwei Drittel der am Infarkt Verstorbenen in Berlin außerhalb der Kliniken. Der Herzinfarkttod außerhalb der Kliniken betraf bevorzugt Jüngere und variierte jahreszeitlich. Das im Vergleich zur stationären Sterblichkeit nach wie vor hohe Ausmaß der Herzinfarktsterblichkeit außerhalb der Kliniken sollte vermehrte Anstrengungen zu wissenschaftlich begleiteter verbesserter Prävention und Versorgung stimulieren.During the past 2 decades, improvement and advancements in coronary reperfusion and optimized medical therapy have enabled a marked reduction of hospital mortality in patients with myocardial infarction, while pre-hospital mortality has not been favourably influenced in equal measure. This study aims at describing those who died from myocardial infarction during one year in the city of Berlin, with particular focus on the comparison of in-hospital versus out-of-hospital mortality.We examined data from centrally archived death certificates issued between July 2014 and June 2015 and identified 1076 cases of myocardial infarction; the certificates stated that myocardial infarction was the direct cause of death in explicit words or by reference to ICD codes. All cases were included in our study anonymously.During the study period, 1076 deaths from myocardial infarction were identified; 66% died out of hospital, whereas 34% died in a hospital. There were no differences between those dying in and those out of hospital in the percentage of women (40.4% in, 39.0% out of hospital; p=0.671), frequency of post-mortem examinations (16.8–16.6%; p=0.938) or in death category “not natural” and “uncertain” (17.1–19.3%; p=0.388). There were differences in age and month of death. Those dying outside of the hospital were on average younger (76 yrs.) than those dying in hospital (80 yrs.). The biggest differences were seen in the youngest age groups65 years with 76.3% dying out of hospital and 23.7% in hospital. Between July and September, the relative proportion of those dying out of hospital was lowest (15.4%), and for those dying in hospital, this proportion was the highest (29.4%). This tendency was the same for men and women as well as younger and older patients.In this study, two-thirds of deaths from myocardial infarction occurred outside of the hospital. Out-of-hospital death occurs predominantly among younger individuals and varies by season of the year. The high level of pre-hospital deaths from myocardial infarction should stimulate intense efforts to improve prevention and emergency management of patients based on scientific evaluation.

Health registries could be used to analyze questions concerning routine practice in healthcare. Therefore, registries are a core method in health services research. The German Network for Health Services Research (Deutsches Netzwerk Versorgungsforschung, DNVF) promotes the quality of registries by scientific exchange, organization of advanced training, and recommendations in the form of a memorandum "Registry for Health Services Research". The current recommendations are an update of the memorandum's first version of 2010. The update describes the capabilities and aims of registries in health services research. Furthermore, it illustrates the state-of-the-art in designing and implementing health registries. The memorandum provides developers the methodological basis to ensure high quality health registries. It further provides users of health registries with insights that enable assessing the quality of data and results of health registries. Finally, funding agencies and health policy actors can use the quality criteria to establish a framework for the financing and legislative requirements for health registries. The memorandum provides first a definition of health registries and presents an overview of their utility in health services research and health care improvement. Second, several areas of methodological importance for the development and operation of health registries are presented. This includes the conceptual and preliminary design, implementation, technical organization of a health registry, statistical analysis, reporting of results, and data protection. From these areas, criteria are deduced to allow the assessment of the quality of a health registry. Finally, a checklist is presented.Über Register können Fragestellungen zur Gesundheitsversorgung im Alltag untersucht werden. Sie sind daher eine wesentliche Methode der Versorgungsforschung. Das Deutsche Netzwerk Versorgungsforschung (DNVF) fördert die Qualität von Registern durch einen wissenschaftlichen Austausch, durch Fortbildungsangebote sowie durch Empfehlungen in Form eines Memorandums „Register für die Versorgungsforschung“. Die vorliegenden Empfehlungen stellen ein Update zur ersten Fassung des Memorandums von 2010 dar. Das Update beschreibt die Einsatzmöglichkeiten und Zielsetzungen von Registern in der Versorgungsforschung und stellt den aktuellen Stand zu allen Aspekten eines guten Designs und eines sachgerechten Betriebs von Registern dar. Das Memorandum kann Verantwortlichen für die Entwicklung eines Registers als Leitfaden zur Erreichung einer hohen Qualität dienen; potentiellen Nutzern von Daten und Ergebnissen aus Registern ermöglicht es, die Qualität eines Registers zu bewerten. Projektförderer und Gesundheitspolitik können sich bei der Rahmensetzung für Finanzierung und gesetzliche Anforderungen an den Qualitätskriterien orientieren. Neben einer Definition werden im Memorandum verschiedene für die Konzeption eines Registers relevante Bereiche vorgestellt. Dies umfasst die Phasen der Entwicklung eines Registers von der Planung über den Entwurf bis zur Umsetzung, die technische Organisation und den Betrieb eines Registers, die Auswertung von Registerdaten, die Berichterstattung über die Ergebnisse sowie den Datenschutz. Aus diesen Bereichen abgeleitete Kriterien zur Beurteilung der Qualität eines Registers werden beschrieben. Hierfür wird abschließend eine Checkliste präsentiert.

Individual data linkage of different data sources for research purposes is being increasingly used in Germany in recent years. However, generally accepted methodological guidance is missing. The aim of this article is to define such methodological standards for research projects. Another aim is to provide readers with a checklist for critical appraisal of research proposals and articles. Since 2016, an expert panel of members of different German scientific societies have worked together and developed 7 guidelines with a total of 27 practical recommendations. These recommendations include (1) research aims, questions, data sources and resources, (2) infrastructure and data flow, (3) data privacy, (4) ethics, (5) key variables and type of linkage, (6) data validation/quality assurance and (7) long-term use for future research questions. The authors provide a rationale for each recommendation. Future revisions will include any new developments in science and data privacy.Das personenbezogene Verknüpfen verschiedener Datenquellen (Datenlinkage) für Forschungszwecke findet in den letzten Jahren in Deutschland zunehmend Anwendung. Jedoch fehlen hierfür konsentierte methodische Standards. Ziel dieses Beitrages ist es, solche Standards für Forschungsvorhaben zu definieren. Eine weitere Intention ist es, dem Lesenden eine Checkliste zur Bewertung geplanter Forschungsvorhaben und Artikel bereitzustellen. Zu diesem Zweck hat eine aus Mitgliedern verschiedener Fachgesellschaften zusammengesetzte Expertengruppe seit 2016 insgesamt 7 Leitlinien mit 27 konkreten Empfehlungen erstellt. Die Gute Praxis Datenlinkage beinhaltet die folgenden Leitlinien: (1) Forschungsziele, Fragestellung, Datenquellen und Ressourcen, (2) Dateninfrastruktur und Datenfluss, (3) Datenschutz, (4) Ethik, (5) Schlüsselvariablen und Linkageverfahren, (6) Datenprüfung/Qualitätssicherung sowie (7) Langfristige Datennutzung für noch festzulegende Fragestellungen. Jede Leitlinie wird ausführlich diskutiert. Zukünftige Aktualisierungen werden wissenschaftliche und datenschutzrechtliche Entwicklungen berücksichtigen.

Zusammenfassung: Das Berliner Herzinfarktregister erhebt seit 1999 Daten zur Versorgung von Herzinfarktpatienten in Berliner Kliniken. Mit diesen Daten lassen sich Entwicklungen zum Risikofaktorenprofil und zur Versorgung der Patienten über die Zeit darstellen. Es nahmen Patienten mit Hypertonie und Hypercholesterinämie zu. Mit 76% war der Anteil an Rauchern bei den

In recent years, linking different data sources, also called data linkage or record linkage, to address scientific questions, is being increasingly used in Germany. However, there are very few published reports and new projects develop the necessary tools independently of each other. Therefore, a team of researchers joined together to exchange their experiences on data linkage and to give suggestions on how linkage could be done for scientists, reviewers as well as members of data privacy boards and ethics committees. It is the aim of this article to assist future projects that want to link German data on an individual level. In addition to the legal framework conditions (data privacy), also examples of types of data linkage, their fields of application und potential pitfalls as well as the methods of preventing them will be described in an application-oriented fashion.Die Verknüpfung verschiedener Datenquellen, genannt Datenlinkage oder auch Record Linkage, zur Beantwortung von wissenschaftlichen Fragestellungen findet in den letzten Jahren in Deutschland vermehrt Anwendung. Jedoch mangelt es bisher an publizierten Erfahrungen. Neue Projekte erarbeiten sich in der Regel autark voneinander das notwendige Handwerkszeug. Daher hat sich eine Gruppe von Forschern zusammengefunden, um ihre Erfahrungen zum Datenlinkage in Deutschland als mögliche Hilfestellung bzw. Anregung für Projekte, Gutachter sowie Datenschützer und Ethikkommissionen zusammenzustellen. Ziel dieser ersten Bestandsaufnahme zum Datenlinkage ist es deshalb, eine Unterstützung für zukünftige Projekte zu liefern, die Daten aus Deutschland auf individueller Ebene verknüpfen möchten. Neben den (datenschutz-)rechtlichen Rahmenbedingungen werden dabei auch praxisorientiert die Arten des Datenlinkage, deren Anwendungsfelder und Ansätze zur Vermeidung von Fehlern anhand von Beispielen dargestellt.

Background Assessment of quality of care in patients with myocardial infarction (MI) should be based on data that effectively enable determination of quality. With the need to simplify measurement techniques, the question arises whether routine data can be used for this purpose. We therefore compared data from a German sickness fund (AOK) with data from the Berlin Myocardial Infarction Registry (BMIR). Methods We included patients hospitalised for treatment of MI in Berlin from 2009-2011. We matched 2305 patients from AOK and BMIR by using deterministic record linkage with indirect identifiers. For matched patients we compared the frequency in documentation between AOK and BMIR for quality assurance variables and calculated the kappa coefficient (KC) as a measure of agreement. Results There was almost perfect agreement in documentation between AOK and BMIR data for matched patients for: catheter laboratory (KC: 0.874), ST elevation MI (KC: 0.826), diabetes (KC: 0.818), percutaneous coronary intervention (KC: 0.860) and hospital mortality (KC: 0.952). The remaining variables compared showed moderate or less than moderate agreement (KC

BACKGROUND Optimizing the emergency medical care chain might shorten the time to treatment of patients with ST-elevation myocardial infarction (STEMI). The initial care by a physician, and, in particular, correct ECG interpretation, are critically important factors. METHODS From 1999 onward, data on the care of patients with myocardial infarction have been recorded and analyzed in the Berlin Myocardial Infarction Registry. In the First Medical Contact Study, data on initial emergency medical care were obtained on 1038 patients who had been initially treated by emergency physicians in 2012. Their pre-hospital ECGs were re-evaluated in a blinded fashion according to the criteria of the European Society of Cardiology. RESULTS The retrospective re-evaluation of pre-hospital ECGs revealed that 756 of the 1038 patients had sustained a STEMI. The emergency physicians had correctly diagnosed STEMI in 472 patients (62.4%), and they had correctly diagnosed ventricular fibrillation in 85 patients (11.2%); in 199 patients (26.3%), the ECG interpretation was unclear. The pre-hospital ECG interpretation was significantly associated with the site of initial hospitalization and the ensuing times to treatment. In particular, the time from hospital admission to cardiac catheterization was longer in patients with an unclear initial ECG interpretation than in those with correctly diagnosed STEMI (121 [54; 705] vs. 36 [19; 60] minutes, p

Background It is under discussion whether female patients with non-ST-elevation myocardial infarction (NSTEMI) benefit from routine invasive treatment strategy. We accordingly applied our data from the Berlin Myocardial Infarction Registry (BMIR) to analyze the association between early percutaneous coronary intervention (PCI) and hospital mortality in NSTEMI patients. Methods Data prospectively collected in the BMIR between 2004 and 2008 from 2808 patients (m=1820/w=988) directly admitted to hospitals with 24-h PCI facilities were included in the analysis. After adjustment for confounding variables, we compared in-hospital mortality for patients of both sexes with vs. without early PCI. Results Women with NSTEMI were, on average, 7years older than men and demonstrated significantly more comorbidities. A GPIIb/IIIa antagonist was applied in women less often than in men (31.4% vs. 38.4%, p=0.001), and an early PCI was also performed less often in women than in men (64.0% vs. 76.2%, p Conclusion In our clinical registry, early PCI in female patients with NSTEMI was not associated with lower hospital mortality. Further randomized-controlled trials are needed to better understand which women may benefit from early invasive therapy, and under which conditions such benefits are possible.

Our study aimed to analyse the hospital mortality of patients admitted in- and off-regular working hours with ST-elevation myocardial infarction (STEMI) within the special logistical setting of the urban area of the city of Berlin.There is a debate whether patients with acute myocardial infarction admitted to hospital outside regular working hours experience higher mortality rates than those admitted within regular working hours.This study analyses data from the Berlin Myocardial Infarction Registry and comprises 2,131 patients with STEMI and treated with percutaneous coronary intervention (PCI) in 2004-2007. Data of patients admitted during in- and off-regular working hours were compared.There was significant difference in door-to-balloon time (median in-hours: 79 min; median off-hours: 90 min, p0.001) and in hospital mortality (in-hours: 4.3%; off-hours: 6.8%, p = 0.020) between STEMI patients admitted in- and off-hours for treatment with PCI. After adjustment, admission off-hours remained an independent predictor for in-hospital death for patients (OR = 2.50; 95% CI 1.38-4.56). In patients with primary care from physician-escorted Emergency Medical Services (EMS), door-to-balloon time was reduced by 10 min for in-hours as well as off-hours patients. The difference in hospital mortality between off-hour and in-hour admission was reduced to a non-significant OR = 1.61 (95% CI 0.79-3.27).In conclusion, patients admitted off-hours experienced longer door-to-balloon times and higher hospital mortality than did those admitted in-hours. The differences observed between patients admitted in-hours and off-hours were reduced through physician-escorted EMS reflecting the influence of optimized STEMI care.

Guidelines for treatment of patients with myocardial infarction (MI) have been regularly updated. In addition, a new definition for acute MI has been recently established. The aim of our study was to evaluate development of treatment and effects on patient outcome.We prospectively collected data from MI patients who were treated in 22 hospitals in Berlin, Germany, during the years 1999 to 2004. In the study we consecutively included 6080 MI patients presenting with (STEMI, n=4314) and without persistent ST-segment elevation (NSTEMI, n=1766).STEMI and NSTEMI patients showed an increase over time in arterial hypertension, smoking, hypercholesterolaemia, history of congestive heart failure, and renal failure. The application of acute percutaneous coronary intervention increased from 15.3% to 62.3% (p0.001) for NSTEMI and from 24.7% to 71.8% (p0.001) for STEMI patients. Concomitant therapy with beta-blockers, ACE inhibitors, statins, GP IIb/IIIa, and aspirin increased in parallel in both groups. The decrease in hospital mortality was more pronounced for NSTEMI (13.5% vs. 4.6%, p0.001) than with STEMI patients (13.0% vs. 9.4%, p=0.005).Adherence to guidelines has led to a higher level of hospital care for NSTEMI and STEMI patients. Hospital mortality decreased for both groups, with a greater impact on NSTEMI patients.

Guidelines issued by European and German cardiology societies clearly define procedures for treatment of acute myocardial infarction (AMI). These guidelines, however, are based on clinical studies in which older patients are underrepresented. Older patients, on the other hand, represent a large and growing portion of the infarction population. It was our goal in the present paper to analyse the present treatment of AMI patients over 75 years of age in the city of Berlin, Germany, with data gained from the Berlin Myocardial Infarction Registry (BHIR).We prospectively collected data from 5079 patients (3311 men and 1768 women, mean age 65.6) with acute myocardial infarction who were treated in 25 hospitals in Berlin during the period 1999-2003. 1319 patients (25.9%) were older than 75 (mean age 82.5 years).Overall hospital mortality rate was 11.6%. In patients over 75, this rate was 23.9%; among the younger infarction population, it was 7.3%. In contrast to the younger AMI patients, the majority of those over 75 were female (62.5 vs 25.1% for the younger) and demonstrated a significantly higher frequency of all prognostically meaningful comorbidities (heart failure 14.4% vs. 3.5%; renal failure 11.5 vs 3.9%; diabetes 37.3 vs 24.3%). Clinical signs of severe infarction, moreover, were more common among the aged patients (pulmonary congestion 45.4 vs 19.7%; left bundle branch block 12.7 vs 3.6%). Pre-hospital time was prolonged (2.8 vs 2 h) and guideline-recommended therapy was applied significantly less frequently to AMI patients over 75 (reperfusion therapy 39.8 vs 71.7%, beta-blockers 62.8 vs 78.3%, statins 26.5 vs 45.5%). Multivariate analysis revealed the following factors to be independent predictors of hospital mortality in patients over 75: age (OR 1.05 per year), acute heart failure (OR 2.39), pre-hospital resuscitation (OR 10.6), cardiogenic shock (OR 2.73), pre-hospital delay12 h (OR 1.68), and ST elevation in the first ECG (OR 2.09). Independent predictors of a favourable hospital course were as follows: admission to a hospital600 beds (OR 0.64), reperfusion therapy (OR 0.63), early betablocker treatment (OR 0.46), and early application of ACE inhibitors (OR 0.48).Infarction patients over 75 have a very high hospital complication and mortality rate. They are typically treated with delay, and with less adherence to relevant guidelines than are younger patients. Reperfusion therapy, early administration of beta-blockers and ACE inhibitors, as well as admission to large medical centres are all factors that contribute to a favourable prognosis of high-aged AMI patients.

It is under discussion whether female patients with non-ST-elevation myocardial infarction (NSTEMI) benefit from routine invasive treatment strategy. We accordingly applied our data from the Berlin Myocardial Infarction Registry (BMIR) to analyze the association between early percutaneous coronary intervention (PCI) and hospital mortality in NSTEMI patients.Data prospectively collected in the BMIR between 2004 and 2008 from 2808 patients (m=1820/w=988) directly admitted to hospitals with 24-h PCI facilities were included in the analysis. After adjustment for confounding variables, we compared in-hospital mortality for patients of both sexes with vs. without early PCI.Women with NSTEMI were, on average, 7years older than men and demonstrated significantly more comorbidities. A GPIIb/IIIa antagonist was applied in women less often than in men (31.4% vs. 38.4%, p=0.001), and an early PCI was also performed less often in women than in men (64.0% vs. 76.2%, p0.001). In-hospital mortality was higher in women than in men (5.4% vs. 3.6%, p=0.027). In female patients with NSTEMI, after adjustment for differences in patients' characteristics, hospital mortality did not differ between those treated with early PCI and those managed conservatively (OR: 1.24, 95% CI 0.53-2.91). In contrast, hospital mortality in male patients was lower in those treated with an early PCI (OR: 0.41, 95% CI 0.21-0.78).In our clinical registry, early PCI in female patients with NSTEMI was not associated with lower hospital mortality. Further randomized-controlled trials are needed to better understand which women may benefit from early invasive therapy, and under which conditions such benefits are possible.

Background Women with acute myocardial infarction (AMI) exhibit greater hospital mortality than do men. In general, diabetes mellitus is one of the major factors influencing the outcome of patients with AMI. The aim of this study was to analyze the interaction between diabetes and gender, specifically with regard to the higher hospital mortality of female AMI patients aged ≤ 75 years. Methods We prospectively collected data from 3,715 patients aged ≤ 75 (2,794 men, 921 women) with acute myocardial infarction who were treated in 25 hospitals in Berlin, Germany, from 1999 to 2002. In a multivariate analysis, we specifically studied the interaction between the factors diabetes mellitus and gender in their effects on hospital mortality. Results After adjustment in multivariate analysis, the interaction between gender and diabetes was statistically significant, and the estimated odds ratios were as follows: female diabetic patients compared with male diabetic patients, odds ratio (OR) = 2.28 (95% confidence interval [CI] 1.42-3.68); female diabetic patients compared with male nondiabetic patients, OR = 2.90 (95% CI 1.90-4.42); and female diabetic patients compared with female nondiabetic patients, OR = 2.92 (95% CI 1.75-4.87). There was no statistically significant difference between the risk of dying for female nondiabetic patients or for male diabetic patients when compared with male nondiabetic patients. Conclusions In AMI patients aged ≤ 75 years, female gender alone is not an independent predictor of hospital mortality. Detailed, multivariate analysis reveals that specifically diabetic women demonstrate higher hospital mortality than do men. Special attention should be provided to these female diabetic patients.

This study aimed to describe the situation of pregnant teenagers and their motherhood in Burkina Faso the situation of their children the factors contributing to pregnancy and the implications. Data were obtained from focus group interviews of 28 student mothers repeated in depth interviews with 3 of the girls and interviews with 20 teachers 4 parents of student mothers and 9 medical personnel from family planning and maternity services. Information was double checked with clinic records. Interviews were carried out in 1991 in 3 secondary schools of a small town (30000 persons) in Burkina Faso. The results were presented on family reactions student and teacher reactions the fathers role mothers continuing education the childs situation attitudes toward contraception and pregnancy student mothers social environment factors related to student pregnancies (lack of knowledge ambiguous motivation societys conflicting messages student self-esteem) and recommendations for sex education. Parental reaction was generally negative and nonsupportive. Mothers aged 15-17 years were treated particularly by the boys with disrespect and teasing because of late arrivals or clothing with evident signs of infant care. Girls aged 18-20 years were not so affected. Teachers tended to ignore the pregnancies or motherhood. Student mothers viewed themselves as unchaste and old. Relationships with the father varied according to their means and abilities. Girls refused offers of marriage because it would prevent further schooling which was considered desirable for a future job and respect from a husband. Continuing ones education was found not to be compatible with raising an infant. Girls usually live with their child and find a relative to care for the bottle-fed baby during the schoolday; if child care difficulties arise the baby might even die. Student mothers showed reluctance to use modern contraceptives and held a low opinion of family planning services. Not all of the girls wanted to be pregnant and desired to end their pregnancies. There awareness of a variety of abortion methods. The social environment was viewed by teachers as a reason for the rise in teen pregnancies. Suggestions were to initiate early sex education include discussion of psychological behavioral and normative aspects offer contraceptive group sessions for same sex involve parents and improve health care service delivery.