May 2, 2026Journal of the American College of Cardiology74 citations

Mortality Trends After Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction

PTPernille Gro ThraneInterventional Cardiology KOKevin Kris Warnakula OlesenInterventional Cardiology TTTroels ThimAarhus University

Structured PICO

Does contemporary primary PCI for STEMI improve mortality compared to earlier eras in a high-income European country?

Population

19,613 first-time PCI-treated patients undergoing primary PCI for STEMI, median age 64 years, 74% male, in Western Denmark.

Intervention

Primary percutaneous coronary intervention (pPCI) for STEMI in recent years (2015-2018)

Comparator

Primary PCI for STEMI in earlier years (2003-2006)

Outcome

1-year mortality, 30-day mortality, and 31- to 365-day mortalityhard clinical

One-year mortality after primary PCI for STEMI decreased substantially between 2003 and 2018 in Western Denmark, with the largest reduction occurring within the first 30 days.

Abstract

BACKGROUND Observational studies have reported that mortality rates after ST-segment elevation myocardial infarction (STEMI) have been stable since 2006 to 2010. OBJECTIVES The aim of this study was to evaluate the temporal trends in 1-year, 30-day, and 31- to 365-day mortality after STEMI in Western Denmark where primary percutaneous coronary intervention (PCI) has been the national reperfusion strategy since 2003. METHODS Using the Western Denmark Heart Registry, the study identified first-time PCI-treated patients undergoing primary PCI (pPCI) for STEMI from 2003 to 2018. Based on the year of pPCI, patients were divided into 4 time-interval groups and followed up for 1 year using the Danish national health registries. RESULTS A total of 19,613 patients were included. Median age was 64 years, and 74% were male. 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: adjusted HR aHR: 0.71; 95% 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 In a high-income European country with a fully implemented pPCI strategy, 1-year mortality in pPCI-treated patients with STEMI decreased substantially between 2003 and 2018. Approximately three-quarters of the absolute mortality reduction occurred within the first 30 days after pPCI. These results indicate that optimization of early management of pPCI-treated patients with STEMI offers great opportunities for improving overall survival in contemporary clinical practice.

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