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Mortality Trends After Primary PCI for STEMI
Quick Takes
- This study from a high-income European country, where primary PCI has been the strategy for all STEMI patients, reports that 1-year mortality was reduced by approximately 30% from 2003-2006 to 2015-2018.
- These results suggest that optimal early management of STEMI patients, including reductions in time delays and increased use of new guideline-directed pharmacological and interventional treatments, offers excellent opportunities for improving overall survival in contemporary clinical practice.
- There is a need for additional efforts to reduce treatment delay, optimize periprocedural treatment, and understand national and regional variations to further improve outcomes.
Study Questions:
What are the temporal trends in 1-year, 30-day, and 31- to 365-day mortality after ST-segment elevation myocardial infarction (STEMI) in Western Denmark where primary percutaneous coronary intervention (pPCI) has been the reperfusion strategy since 2003?
Methods:
The investigators identified first-time PCI-treated patients undergoing pPCI for STEMI from 2003 to 2018 using the Western Denmark Heart Registry. Based on the year of pPCI, patients were divided into four time-interval groups and followed for 1 year using the Danish national health registries. Cumulative incidence proportion curves were constructed based on the Kaplan-Meier estimator. A Cox proportional hazards model was used to estimate crude and adjusted hazard ratios (aHRs).
Results:
A total of 19,613 patients were included. Median age was 64 years and 74% were men. One-year mortality decreased gradually from 10.8% in 2003-2006, 10.4% in 2007-2010, 9.1% in 2011-2014, to 7.7% in 2015-2018 (2015-2018 vs. 2003-2006: aHR, 0.71; 95% confidence interval [CI], 0.62-0.82). The largest absolute mortality decline occurred in the 0- to 30-day period with a 2.3% reduction (aHR, 0.69; 95% CI, 0.59-0.82), and to a lesser extent in the 31- to 365-day period (risk reduction, 1.0%; aHR 0.71; 95% CI, 0.56-0.90).
Conclusions:
The authors report that 1-year mortality in pPCI-treated STEMI patients decreased substantially between 2003 and 2018.
Perspective:
This study from a high-income European country, where pPCI has been the strategy for all STEMI patients since 2003, reports that 1-year mortality was reduced by approximately 30% from 2003-2006 to 2015-2018, with three quarters of this mortality reduction seen within the first 30 days. These results suggest that optimal early management of STEMI patients, including reductions in time delays and increased use of new guideline-directed pharmacological and interventional treatments, offers great opportunities for improving overall survival in contemporary clinical practice. There is a need for additional efforts to reduce treatment delay, optimize periprocedural treatment, and understand national and regional variations to further improve outcomes.
Clinical Topics: Acute Coronary Syndromes, Invasive Cardiovascular Angiography and Intervention, Prevention, Stable Ischemic Heart Disease, Vascular Medicine, Interventions and ACS, Interventions and Vascular Medicine, Chronic Angina
Keywords: Acute Coronary Syndrome, Anterior Wall Myocardial Infarction, Mortality, Patient Care Team, Percutaneous Coronary Intervention, Reperfusion, Secondary Prevention, ST Elevation Myocardial Infarction, Time-to-Treatment, Treatment Outcome
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