Relative survival rate over twenty years of follow-up in younger patients with STEMI treated by primary percutaneous coronary intervention

INTRODUCTION: Primary percutaneous coronary intervention (pPCI) has been the gold standard treatment for patients with ST-elevation myocardial infarction (STEMI) in Europe for nearly two decades. While short- and medium-term outcomes are well described, data on very long-term mortality, especially in younger patients with longer life expectancy, remain limited. AIM: To analyze very long-term mortality and 20 years relative survival rate compared to the general population in younger patients (≤65 years) with a first STEMI treated by pPCI. METHODS: We analyzed a high-volume, single-center registry of unselected STEMI patients treated with pPCI between January 1, 2000, and December 31, 2002. Patients aged ≤65 years with no history of myocardial infarction (MI) were selected. In cooperation with the Institute of Health Information and Statistics of the Czech Republic, we obtained mortality and cause-of-death data (classified by ICD-10) with a censoring date of December 31, 2023. Observed survival was assessed using the Kaplan-Meier method, and relative survival was estimated using the Pohar-Perme method, with expected survival derived from Czech national mortality tables. RESULTS: A total of 960 patients (71.4 % male, n = 686) with STEMI were treated with pPCI during the three-year study period. Among them, 385 patients (40.1 %) were ≤ 65 years with no previous MI. The mean age at STEMI was 55.03 ± 6.97 years for women (n = 71) and 54.16 ± 6.85 years for men (n = 314; p = 0.168). Over the entire very-long term follow-up period, 211 patients (54.8 %) died; cardiovascular causes were responsible in 111 cases (28.8 %). The 20-year overall survival was 50.6 %, while the 20-year relative survival was 79.5 %. CONCLUSION: Despite high overall very-long term mortality in patients treated with primary PCI, the relative 20-year survival compared to the general population remained nearly 80 %. Furthermore, cardiovascular causes accounted for only half of all deaths.