Key result
Advancements in therapeutic strategies over 20 years reduced all-cause mortality after high-risk myocardial infarction from 9.9 to 4.2 per 100 patient-years (HR 0.41; 95% CI 0.37-0.46; p<0.001).
Why the study?
Has mortality after high-risk myocardial infarction decreased over the past 20 years?
Cohort (n=15,278)
Has mortality after high-risk myocardial infarction decreased over the past 20 years?
Hazard Ratio: 0.41 (95% CI 0.37–0.46)
Absolute Event Rate: 4.2% vs 9.9%
p-value: p=< 0.001
There has been a significant decline in mortality following high-risk myocardial infarction over the past 20 years, driven primarily by a reduction in cardiovascular deaths.
In this column, we want to provide clinicians and researchers with short and concise summaries of recently published studies in the European Journal of Heart Failure that we think are of particular relevance to heart failure (HF) specialists (Figure 1).Key points are temporal changes in outcome after high-risk myocardial infarction (MI), the role of revascularization in patients with HF with reduced ejection fraction (HFrEF), and the risk of incident HF in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) as well as in patients with autoimmune disease. Temporal changes in outcomes after high-risk myocardial infarction over the last 20 yearsAdvancements in therapeutic strategies and medical treatments have led to a significant decline in mortality over the past decades following acute MI. 1-3 Fo et al. 4 performed a pooled analysis of the Valsartan in Acute Myocardial Infarction (VALIANT) and the Prospective ARNI versus ACE Inhibitor Trial to Determine Superiority in Reducing Heart Failure Events after Myocardial Infarction (PARADISE-MI) trials in order to compare the clinical characteristics, outcomes and impact of therapeutic strategies.The two trials were conducted 20 years apart but had comparable inclusion criteria.Participants from VALIANT (study recruitment December 1998 and June 2001) were matched for those of the PARADISE-MI trial (study recruitment December 2016 and March 2020) constituting a population of high-risk MI survivors.Overall, 15 278 participants were included in the analysis and follow-up was 25 and 22 months for the VALIANT and PARADISE-MI trials, respectively.All-cause mortality was 9.9 per 100 patient-years in VALIANT participants compared to 4.2 per 100 patient-years in PARADISE-MI participants (hazard ratio [HR] 0.41, 95% confidence interval [CI] 0.37-0.46,p < 0.001).This significant reduction in mortality was primarily driven by a decrease in cardiovascular (CV) deaths, from 16.8% to 6.3%, while non-CV mortality remained largely unchanged.Among patients
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Hoevelmann et al. (2025) conducted a cohort in High-risk myocardial infarction (n=15,278). Recent therapeutic strategies (PARADISE-MI cohort) vs. Historical therapeutic strategies (VALIANT cohort) was evaluated on All-cause mortality (HR 0.41, 95% CI 0.37-0.46, p=< 0.001). Advancements in therapeutic strategies over 20 years reduced all-cause mortality after high-risk myocardial infarction from 9.9 to 4.2 per 100 patient-years (HR 0.41; 95% CI 0.37-0.46; p<0.001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: