A new study from Denmark conducted over a 16-year period shows a 30% reduction in the 1-year mortality rate following percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). The results may be due to adoption of optimal early management of patients, including reductions in time delays and uptake of guideline-directed treatments, researchers say.
Denmark, a country with a PCI-based strategy and fast uptake of guideline-recommended therapy, is ideal for studying changes in STEMI mortality.
The study, which used linked registries, included 19,613 patients, median age 64 years and almost 75% male, receiving first time treatment with PCI for STEMI from 2003-2018.
Researchers divided patients into four groups according to the year of PCI.
They compared mortality in these patients with age- and sex-matched individuals (1:5 ratio) without a history of MI, PCI, or coronary artery bypass grafting (CABG) from the western Denmark general population.
The study outcome was all-cause mortality at 1 year, 0 to 30 days, and 31 to 365 days.
From 2003 to 2018, 1-year mortality gradually decreased in PCI-treated patients with STEMI, from 10.8% in 2003-2006, to 10.4% in 2007-2010, 9.1% in 2011-2014, and 7.7% in 2015-2018. After adjustment for confounders, this corresponded to a relative risk reduction of 29% (adjusted hazard ratio, 0.71; 95% CI, 0.62 – 0.82).
The largest absolute decline in mortality was between 0 and 30 days after PCI: 2.3% compared with 1.0% in the 31- to 365-day period.
The improvement in cardiovascular prognosis coincided with optimization of prehospital triage, increased use of secondary preventative treatments, and changes in the PCI procedure, including implantation of newer-generation drug-eluting stents (DES).
While mortality was reduced by 0.7% in the matched general population (decreasing from 3.2% in 2003-2006 to 2.5% in 2015-2018), the absolute mortality decline in patients with STEMI was about 4.5-fold as large.
The results indicate optimization of early management of PCI-treated patients with STEMI “offers great opportunities for improving overall survival in contemporary clinical practice,” write the authors.
In an accompanying editorial, Timothy D. Henry, MD, from the Lindner Center for Research and Education, The Christ Hospital Health Network, Cincinnati, Ohio, and colleagues, said the findings “are certainly encouraging,” but noted the study may not be applicable to other health systems and patients. For example, it only included patients presenting with their first STEMI, so it’s unknown how mortality rates might be affected by the inclusion of “less frequent, but often catastrophic, presentations of STEMI.”
The study was conducted by Pernille Gro Thrane, MD, Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark, and colleagues. It was published online in the September 2023 issue of the Journal of the American College of Cardiology.
The study was observational, which precludes conclusions on causal relationships. Data on prehospital delays were available only for the last part of the study period. Out-of-hospital cardiac arrest was not explicitly registered in the database but was included as a composite measure of “critical preoperative condition.” However, this variable did display an overall stable trend.
The study was supported by the Aase and Ejnar Danielsen Foundation. Thrane and Henry report no relevant financial relationships; for disclosures of other authors, see the study and the editorial.
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