Hospitalization for STEMI between 2000 and 2008 was associated with an 80% reduction in adjusted 30-day mortality compared to 1985-1990 (OR 0.20), reflecting improvements in clinical practice.
Observational (n=14,434)
No
Does the implementation of modern treatment modalities over time improve short- and long-term survival in patients hospitalized for acute myocardial infarction?
The progressive implementation of modern guideline-directed medical and interventional therapies between 1985 and 2008 was associated with an approximately 80% reduction in 30-day mortality for both STEMI and NSTEMI patients.
Odds Ratio: 0.2 (95% CI 0.14–0.28)
Tasa de eventos absoluta: 6% vs 17%
Reducción absoluta del riesgo: 11%
valor p: p=<0.001
OBJECTIVES: To quantify the impact of the implementation of treatment modalities into clinical practice since 1985, on outcome of patients with ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI). METHODS: All consecutive patients admitted for STEMI or NSTEMI at the Thoraxcenter between 1985 and 2008 were included. Baseline characteristics, pharmacological and invasive treatment modalities, and survival status were collected. The study population was categorised in three groups of patients: those hospitalised between 1985-1990, 1990-2000, and 2000-2008. RESULTS: We identified 14,434 patients hospitalised for myocardial infarction (MI). Both STEMI and NSTEMI patients were increasingly treated with the current guideline based therapy. In STEMI, at 30 days following admission, cumulative mortality rate decreased from 17% in 1985-1990 to 13% in 1990-2000, and to 6% in 2000-2008. Adjusted 30-day and three-year mortality in the last period was 80% and 68% lower than in 1985, respectively. In NSTEMI, at 30 days following admission, cumulative mortality rate decreased from 6% in 1985-1990 to 4% in 1990-2000, and to 2% in 2000-2008. Adjusted 30-day and three-year mortality in the last period was 78% and 49% lower than in 1985, respectively. For patients admitted between 2000 and 2008, 3 year survival of STEMI and NSTEMI patients was 87% and 88%, respectively. CONCLUSIONS: Our results indicate substantial improvements in acute- and long-term survival in patients hospitalised for MI, related to improved acute- as well as long-term treatment. Early medical evaluation in suspected MI and intensive early hospital treatment both remain warranted in the future.
Nauta et al. (Wed,) conducted a observational in Acute Myocardial Infarction (STEMI and NSTEMI) (n=14,434). Admission between 2000-2008 vs. Admission between 1985-1990 was evaluated on 30-day all-cause mortality in STEMI patients (OR 0.20, 95% CI 0.14-0.28, p=<0.001). Hospitalization for STEMI between 2000 and 2008 was associated with an 80% reduction in adjusted 30-day mortality compared to 1985-1990 (OR 0.20), reflecting improvements in clinical practice.
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