**3. Results**

Overall, there were 65,261 hospitalizations with a principal diagnosis at discharge of AMI (initial episode of care) in the decade investigated, among all hospitals operating under the NHS in the Veneto Region (north-east Italy), 55.2% of them (36,035) were STEMI, and 44.8% (29,226) were NSTEMI. The overall mean age of this patient population was 71.1 ± 13.7 years (data not shown).

Figure 1 shows that the incidence of NSTEMI exceeded that of STEMI in the last year of the decade (74.8 vs. 72.7 cases per 100,000 population). This phenomenon was possibly due to a simultaneous decrease in cases of STEMI ( −34%; APC:C-4.8 [ −5.3; −4.4], *p* < 0.001), and increase in NSTEMI (+7%; APC: 1.1 [0.4;1.7], *p* < 0.001). On the whole, the absolute number of hospital admissions for AMI dropped by 18% (APC: −2.3 [ −2.6; −1.9], *p* < 0.001) over the decade.

**Figure 1.** Veneto Region 2007–2016. Temporal trends in hospital admissions for AMI \* (per 100,000 population), initial episode of care, by type of AMI, after direct standardization (reference population: 2012). AMI: acute myocardial infarction. \* APC (CI 95%), *p*-value → All STEMI = −2.3 (−2.6; −1.9), *p* < 0.001; STEMI = −4.8 ( −5.3; −4.4), *p* < 0.001; NSTEMI = 1.1 (0.4;1.7), *p* < 0.001.

The mean age of the STEMI population was 70.1 ± 14.3 years, and males accounted for nearly two thirds of the patients hospitalized with STEMI (men: 66.2%; women: 33.8%). The majority of patients were of Italian citizenship (95.5%) (Table 1). In the decade from 2007 to 2016, 44.6% of patients admitted to hospital for STEMI as their principal diagnosis underwent a PCI within 24 h of admission; and the in-hospital mortality rate for STEMI was 12.2% (Table 1).


**Table 1.** Veneto Region 2007–2016. Characteristics of hospital admissions for STEMI, in-hospital mortality and proportion of PCI on day of admission by gender, age, and citizenship.

PCI: percutaneous coronary intervention; HDC: highly-developed countries; HMPC: high migratory pressure countries.

Table 2 shows the proportion of patients with STEMI treated with PCI within 24 h by socio-demographic factors and year of the study. Throughout the period investigated, this care process indicator was higher for men than for women (e.g., 38.1% vs. 18.6% in 2007), and it increased significantly over time for both genders, and especially for women, though the difference between genders was not statistically significant (APC: 6.3 [5.4;7.3] for men, and APC: 8.6 [6.2;11.1] for women). When age groups were considered, a statistically significant rising trend emerged over the ten-year period, which was statistically far more consistent for patients over 75 years old (APC, 75–84 y: 9.8; >85 y: 12.5) than for younger patients (APC, <45 y: 3.3; 45–64: 4.9). As regards citizenship, the significantly rising trend in the proportion of patients with STEMI treated with PCI within 24 h was confirmed, with no significant differences between the three citizenship groups identified (APC, Italian: 7.2; HDC: 6.1; HMPC: 5.9).

**Table 2.** Veneto Region 2007–2016. Proportion of PCI within 24 h of hospital admission for STEMI by gender, age, and citizenship.


PCI: percutaneous coronary intervention; APC: annual percent change; HDC: highly-developed countries; HMPC: high migratory pressure countries. ◦ *p* < 0.05.

Table 3 shows the proportion of in-hospital deaths among patients treated for STEMI during the period considered, for all the subgroups investigated. Women with STEMI always had a higher in-hospital mortality rate than men (e.g., 18.9% vs. 9.9% in 2007). From 2007 to 2016, the overall observed in-hospital mortality rate declined for both genders, with no significant difference between the trends of the two groups (APC: men, −1.9 [−3.7;0.0]; women, −1.2 [−3.1;0.6]). When the different age groups were analyzed, it emerged that age had a fundamental impact on the chances of PCI within 24 h, but there was no significant difference between the declining mortality trends for the various age groups, except for the 75- to 84-year-olds (APC: −3.0 [−4.5;−1.6]). The same declining mortality trend was apparent for the citizenship subgroups too, leading to a difference that was significant for Italian patients (APC: −1.9 [−3.2;−0.6]), and greater—though it failed to reach statistical significance—for patients from HDC countries (APC: −4.9 [−12.6;3.5]).

**Table 3.** Veneto Region 2007–2016. In-hospital mortality after hospital admission for STEMI by gender, age, and citizenship.


APC: annual percent change; HDC: highly-developed countries; HMPC: high migratory pressure countries. ◦ *p* < 0.05. \* excluded year 2009.

Figure 2 show the results of multilevel logistic regression analyses and the significant associations between the two performance indicators and the different socio-demographic factors, before (2007–2008) and after (2009–2016) the introduction of the network.

ORs for proportion of PCI on day of admission

**Figure 2.** *Cont.*

ORs for in-hospital mortality

**Figure 2.** Veneto Region 2007–2016. Multilevel logistic regression analysis of associations between the two indicators investigated and socio-demographic factors; ORs and 95% confidence intervals, *p* value ◦◦. PCI: percutaneous coronary intervention. \* Reference: Men. ◦ Reference: 45–64 y. \*\* Reference: Italian. ◦◦ full indicator → *p* < 0.05.

Although disparities persisted between genders and age groups, the multivariate analyses confirmed the trend towards a null value in almost all the different categories of socio-demographic factors (where a value of 1 attests to no differences between the factors).
