Differences in treatment and outcome of patients with ST- Elevation Myocardial Infarction (STEMI) and Non-STEMI in Germany

Background ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) are the main diagnoses of acute coronary syndrome (ACS). Although both types of infarction are classed as ACS, the treatment and overall survival rate are different. Methods Health claims data (≈26 million members) were screened for patients with STEMI and NSTEMI from 01/2010 to 12/2018. Patient demographics, hospitalization details, adherence to guideline-directed drug therapy, and survival were assessed. Results The total cohort of acute myocardial infarctions comprised 544,529 patients (mean age 74 (IQR 62 - 82), one third of whom were hospitalized with a STEMI. Patients with STEMI were more likely to be in a life-threatening situation and had higher in-hospital, 30- and 60-day mortality, but better long-term survival. Major adverse cardiac and cerebrovascular events (MACCE), infarct recurrence, chronic kidney disease, peripheral arterial disease, heart failure and cerebrovascular disease were more common in patients with NSTEMI. STEMI-patients received coronary angiography and percutaneous coronary intervention more frequently. Although there was a clear correlation between guideline-compliant therapy and overall survival, adherence to guideline-compliant therapy decreased over time, especially in NSTEMI patients. Conclusion In ACS patients, there are clear differences between STEMI and NSTEMI patients in terms of short- and long-term survival. Guideline-based therapy improved long-term survival in both, but more significantly in STEMI patients.