Improved outcomes in patients with ST-elevation myocardial infarction during the last 20 years are related to implementation of evidence-based treatments: experiences from the SWEDEHEART registry 1995–2014

Abstract

AimsImpact of changes of treatments on outcomes in ST-elevation myocardial infarction (STEMI) patients in real-life health care has not been documented.Methods and resultsAll STEMI cases (n = 105.674) registered in the nation-wide SWEDEHEART registry between 1995 and 2014 were included and followed for fatal and non-fatal outcomes for up to 20 years. Most changes in treatment and outcomes occurred from 1994 to 2008. Evidence-based treatments increased: reperfusion from 66.2 to 81.7%; primary percutaneous coronary intervention: 4.5 to 78.0%; dual antiplatelet therapy from 0 to 89.6%; statin: 14.1 to 93.6%; beta-blocker: 78.2 to 91.0%, and angiotensin-converting-enzyme/angiotensin-2-receptor inhibitors: 40.8 to 85.2% (P-value for-trend <0.001 for all). One-year mortality decreased from 22.1 to 14.1%. Standardized incidence ratio compared with the general population decreased from 5.54 to 3.74 (P < 0.001). Cardiovascular (CV) death decreased from 20.1 to 11.1%, myocardial infarction (MI) from 11.5 to 5.8%; stroke from 2.9 to 2.1%; heart failure from 7.1 to 6.2%. After standardization for differences in demography and baseline characteristics, the change of 1-year CV-death or MI corresponded to a linear trend of 0.915 (95% confidence interval: 0.906–0.923) per 2-year period which no longer was significant, 0.997 (0.984–1.009), after adjustment for changes in treatment. The changes in treatment and outcomes were most pronounced from 1994 to 2008.ConclusionGradual implementation of new and established evidence-based treatments in STEMI patients during the last 20 years has been associated with prolonged survival and lower risk of recurrent ischaemic events, although a plateauing is seen since around 2008.

Microvascular obstruction in ST elevation myocardial infarction patients undergoing primary percutaneous coronary intervention: another frontier to conquer?

“…Over the past decades, a significant reduction in mortality due to ST elevation myocardial infarction (STEMI) has been observed worldwide (1,2). Prompt restoration of the epicardial coronary blood flow with timely primary percutaneous coronary intervention (PCI), as well as adjunctive pharmacological therapies have largely reduced the myocardial infarct size and improved short-and longterm outcomes (3,4).…”

Aminooxyacetic acid attenuates post‐infarct cardiac dysfunction by balancing macrophage polarization through modulating macrophage metabolism in mice

“…In the past 20 years, owing to implementation of evidence‐based treatment, the in‐hospital, 30‐day and 1‐year all‐cause mortality of acute myocardial infarction (AMI) were approximately 43%, 42% and 36% lower, respectively, in 2013‐2014 than in 1995‐1996 . Even so, AMI leads to irreversible loss of myocardial cells and poor left ventricular remodelling, resulting in reduced ejection fraction (<50%, 72% in 1997‐1998 and 52% in 2013‐2014) and subsequent heart failure. More importantly, the mortality seems to have remained constant and not fallen further since around 2008 .…”

“…Even so, AMI leads to irreversible loss of myocardial cells and poor left ventricular remodelling, resulting in reduced ejection fraction (<50%, 72% in 1997‐1998 and 52% in 2013‐2014) and subsequent heart failure. More importantly, the mortality seems to have remained constant and not fallen further since around 2008 . Therefore, new effective therapeutic strategies for MI are still desirable.…”

Circulating lectin pathway proteins do not predict short-term cardiac outcomes after myocardial infarction

“…Although there has been an improvement in prognosis, there is still a residual risk which demonstrates the scientific and therapeutic challenge we are facing in the search for improved treatment of CAD-related diseases such as myocardial infarction (MI) [1,2]. Although there has been an improvement in prognosis, there is still a residual risk which demonstrates the scientific and therapeutic challenge we are facing in the search for improved treatment of CAD-related diseases such as myocardial infarction (MI) [1,2].…”