Key result
Improved STEMI management between 2005 and 2011 was associated with a significant decline in in-hospital and 12-month mortality, though relative 12-month mortality reductions were more related to changes in patients' clinical characteristics, especially in women.
Why the study?
It was unclear how much of the recent mortality decline in STEMI could be attributed to improved treatment strategies versus changes in baseline clinical characteristics, and whether these differed between men and women.
Do improved treatment strategies reduce in-hospital and 12-month mortality in men and women with STEMI?
Observational (n=32,790)
Yes
Do improved treatment strategies reduce in-hospital and 12-month mortality in men and women with STEMI?
Effect estimate: RRR 10%
Absolute Event Rate: 18.8% vs 20.9%
Absolute Risk Reduction: 2.1%
p-value: p=0.019
Advances in STEMI treatment strategies between 2005 and 2011 significantly reduced in-hospital mortality, while 12-month mortality reductions were more strongly driven by changes in baseline clinical characteristics, particularly in women.
May encourage ongoing STEMI protocol optimization; leaves open whether patient characteristics drove most 12-month gains, especially in women.
INTRODUCTION: The aim of this study is to estimate how much of the recent decrease in mortality among patients with myocardial infarction with ST-segment elevation (STEMI) can be attributed to improved treatment strategies, and how much it is related to changes in baseline clinical characteristics, and to compare these findings for men and women. MATERIAL AND METHODS: This was a retrospective analysis of 32,790 patients with STEMI from the Polish Registry of Acute Coronary Syndromes PL-ACS hospitalised in 2005 and 2011. Changes in treatment strategies including pharmacotherapy were analysed. Observed in-hospital and 12-month mortality rates were compared with the outcomes in the groups matched on the propensity scores. RESULTS: There was a substantial improvement in STEMI patient management between 2005 and 2011 in Poland. It included greater use of percutaneous coronary interventions and other guideline-based adjunctive therapies, and it was associated with a significant decline in in-hospital mortality. Relative 12-month mortality reduction rates were less pronounced and more related to changes in patients' clinical characteristics. Higher mortality risk reductions were observed in women and were driven by relatively more positive changes in their baseline risk profiles when compared to men. CONCLUSIONS: The progress in the treatment strategies has helped to achieve better survival rates in STEMI patients. However, the ongoing changes in clinical characteristics of patients also played an important role, especially in women. Clinicians should focus on modifiable risk factors and post-discharge management to possibly prolong the positive aspects of in-hospital efforts.
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Zandecki et al. (2020) conducted an observational in ST-elevation myocardial infarction (STEMI) (n=32,790). Hospitalization in 2011 (improved treatment strategies) vs. Hospitalization in 2005 was evaluated on 12-month all-cause mortality (propensity score matched, women) (RRR 10%, p=0.019). Improved STEMI management between 2005 and 2011 was associated with a significant decline in in-hospital and 12-month mortality, though relative 12-month mortality reductions were more related to changes in patients' clinical characteristics, especially in women.
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