Cent Eur J Public Health 2025, 33(1):49-56 | DOI: 10.21101/cejph.a8462

The role of conservative treatment in regional variations of 30-day acute myocardial infarction mortality: a case of the Czech Republic

Ivo Hlaváč1, Matěj Opatrný2
1 Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
2 Institute of Economic Studies, Faculty of Social Sciences, Charles University, Prague, Czech Republic

Objectives: The aim of the study was to analyse the role of conservative treatment and regional differences in 30-day hospital mortality for acute myocardial infarction (AMI) patients in the Czech Republic.

Methods: Using administrative data from Czech health insurance companies for 2018-2020, we employed a probit model to examine factors influencing mortality across 13 complex cardiovascular centres, calculating average marginal effects to ensure interpretable results.

Results: Conservative treatment was associated with a 4.7 percentage point increase in 30-day mortality compared to percutaneous coronary intervention (PCI) treatment (95% CI: 3.6-5.7). This effect varied significantly across different types of AMI and healthcare providers, with regional variations in mortality ranging from 0 to 4.3 percentage points relative to the best-performing centre.

Conclusions: Higher proportions of conservative treatment significantly contribute to increased 30-day mortality in complex cardiovascular centres. The persistent regional variations after controlling for patient characteristics suggest the need for standardized treatment protocols and improved data collection systems to reduce disparities in outcomes.

Klíčová slova: acute myocardial infarction, conservative treatment, regional variation, mortality, probit model

Vloženo: 11. listopad 2024; Revidováno: 25. březen 2025; Přijato: 25. březen 2025; Zveřejněno: 31. březen 2025  Zobrazit citaci

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Hlaváč I, Opatrný M. The role of conservative treatment in regional variations of 30-day acute myocardial infarction mortality: a case of the Czech Republic. Cent Eur J Public Health. 2025;33(1):49-56. doi: 10.21101/cejph.a8462.
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    Reference

    1. Timmis A, Kazakiewicz D, Townsend N, Huculeci R, Aboyans V, Vardas P. Global epidemiology of acute coronary syndromes. Nat Rev Cardiol. 2023 Nov;20(11):778-88. Přejít k původnímu zdroji... Přejít na PubMed...
    2. Zuin M, Rigatelli G, Temporelli P, Di Fusco SA, Colivicchi F, Pasquetto G, et al. Trends in acute myocardial infarction mortality in the European Union, 2012-2020. Eur J Prev Cardiol. 2023 Nov 9;30(16):1758-71. Přejít k původnímu zdroji... Přejít na PubMed...
    3. Deaths 2020. Technical report. Prague: Institute of Health Information and Statistics of the Czech Republic; 2021.
    4. Bruthans J, Cífková R, Lánská V, O'Flaherty M, Critchley JA, Holub J, et al. Explaining the decline in coronary heart disease mortality in the Czech Republic between 1985 and 2007. Eur J Prev Cardiol. 2014 Jul;21(7):829-39. Přejít k původnímu zdroji... Přejít na PubMed...
    5. Ošťádal P, Mates M. [Acute myocardial infarction]. Prague: Maxdorf; 2023. Czech.
    6. [National Health Information Portal. National cardiovascular plan CR: comprehensive analytical study] [Internet]. Prague: Institute of Health Information and Statistics of the Czech Republic; 2024 [cited 2025 Mar 25]. Available from: https://www.nzip.cz/data/1670-narodni-kardiovaskularni-plan-cr-souhrnna-analyticka-studie. Czech.
    7. Ministry of Health of the Czech Republic. [National cardiovascular plan CR for 2025-2035] [Internet]. Prague: Ministry of Health of the Czech Republic; 2024 [cited 2025 Mar 25]. Available from: https://mzd.gov.cz/narodni-kardiovaskularni-plan-cr-na-obdobi-2025-2035/. Czech.
    8. Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021;42(14):1289-367. Přejít k původnímu zdroji... Přejít na PubMed...
    9. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al; ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018 Jan 7;39(2):119-77. Přejít k původnímu zdroji... Přejít na PubMed...
    10. Puymirat E, Simon T, Cayla G, Cottin Y, Elbaz M, Coste P, et al. Acute myocardial infarction: changes in patient characteristics, management, and 6-month outcomes over a period of 20 years in the FAST-MI Program (French Registry of Acute ST-Elevation or non-ST-elevation Myocardial Infarction) 1995 to 2015. Circulation. 2017 Nov 14;136(20):1908-19. Přejít k původnímu zdroji... Přejít na PubMed...
    11. Lopez AD, Adair T. Is the long-term decline in cardiovascular-disease mortality in high-income countries over? Evidence from national vital statistics. Int J Epidemiol. 2019 Dec 1;48(6):1815-23. Přejít k původnímu zdroji... Přejít na PubMed...
    12. Rozenfeld KL, Lupu L, Merdler I, Morgan S, Banai S, Shacham Y. Invasive versus conservative treatment approach among older adult patients admitted with acute ST-segment elevation myocardial infarction. Ann Geriatr Med Res. 2022 Dec;26(4):347-53. Přejít k původnímu zdroji... Přejít na PubMed...
    13. Hall M, Bebb OJ, Dondo TB, Yan AT, Goodman SG, Bueno H, et al. Guideline-indicated treatments and diagnostics, GRACE risk score, and survival for non-ST elevation myocardial infarction. Eur Heart J. 2018 Nov 7;39(42):3798-806. Přejít k původnímu zdroji... Přejít na PubMed...
    14. Olivari Z, Chinaglia A, Gonzini L, Falsini G, Pilleri A, Valente S, et al. Invasive strategy in non-ST-segment elevation acute coronary syndrome: what should be the benchmark target in the real world patients? Insights from BLITZ-4 Quality Campaign. Int J Cardiol. 2016 Oct 1;220:761-7. Přejít k původnímu zdroji... Přejít na PubMed...
    15. Laukkanen JA, Kunutsor SK, Lavie CJ. Percutaneous coronary intervention versus medical therapy in the treatment of stable coronary artery disease: an updated meta-analysis of contemporary randomized controlled trials. J Invasive Cardiol. 2021 Aug;33(8):E647-57. doi: 10.25270/jic/20.00616. Přejít k původnímu zdroji... Přejít na PubMed...
    16. Bueno H, Rossello X, Pocock SJ, Van de Werf F, Chin CT, Danchin N, et al. In-hospital coronary revascularization rates and post-discharge mortality risk in non-ST-segment elevation acute coronary syndrome. J Am Coll Cardiol. 2019 Sep 17;74(11):1454-61. Přejít k původnímu zdroji... Přejít na PubMed...
    17. Widimský P, Moťovská Z, Táborský M. Acute coronary syndrome (myocardial infarction and unstable angina pectoris) - diagnosis and treatment [Internet]. Prague: Institute of Health Information and Statistics of the Czech Republic; 2019 [cited 2025 Mar 25]. Available from: https://kdp.uzis.cz/index.php?pg=kdp&id=5.
    18. Health Insurance Bureau. 30-day mortality of patients with AMI hospitalized in the Czech Republic. Technical report. Prague: Health Insurance Bureau; 2022.
    19. Harris JK. Primer on binary logistic regression. Fam Med Community Health. 2021 Dec;9 Suppl 1:e001290. doi: 10.1136/fmch-2021-001290. Přejít k původnímu zdroji... Přejít na PubMed...
    20. Miller S, Johnson N, Wherry LR. Medicaid and mortality: new evidence from linked survey and administrative data. Q J Econ. 2021;136(3):1783-829. Přejít k původnímu zdroji...
    21. Wooldridge JM. Introductory econometrics: A Modern approach. 6th ed. Boston: Cengage Learning; 2016.
    22. Greene WH. Econometric analysis. 8th ed. London: Pearson; 2019.
    23. Bidulescu A, Horbal SR, Althouse AD. Statistical methods for cardiovascular outcomes studies. In: Maki KC, Wilson DP, editors. Cardiovascular outcomes research. Contemporary cardiology. Cham: Springer; 2024. p. 19-66. Přejít k původnímu zdroji...
    24. Peterson ED, Dai D, DeLong ER, Brennan JM, Singh M, Rao SV, et al. Contemporary mortality risk prediction for percutaneous coronary intervention: results from 588,398 procedures in the National Cardiovascular Data Registry. J Am Coll Cardiol. 2010 May 4;55(18):1923-32. Přejít k původnímu zdroji... Přejít na PubMed...
    25. Cameron AC, Trivedi PK. Microeconometrics using stata. 2nd ed. College Station: Stata Press; 2022.
    26. Krumholz HM, Lin Z, Keenan PS, Chen J, Ross JS, Drye EE, et al Relationship between hospital readmission and mortality rates for patients hospitalized with acute myocardial infarction, heart failure, or pneumonia. JAMA. 2013 Feb 13;309(6):587-93. Přejít k původnímu zdroji... Přejít na PubMed...
    27. Stolpe S, Kowall B, Werdan K, Zeymer U, Bestehorn K, Weber MA, et al. OECD indicator 'AMI 30-day mortality' is neither comparable between countries nor suitable as indicator for quality of acute care. Clin Res Cardiol. 2024 Dec;113(12):1650-60. Přejít k původnímu zdroji... Přejít na PubMed...

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