Key result
Modern ACS management trends link to ~3-point lower in-hospital mortality over a decade.
Why the study?
ACS management has evolved with widespread adoption of radial access and contemporary mechanical circulatory support, but whether these changes have translated into sustained outcome improvements in an aging population remained uncertain.
Are temporal changes in invasive strategies and reperfusion practice associated with changes in in-hospital mortality over a 10-year period in patients with acute coronary syndrome?
Observational (n=18,762)
Yes
Are temporal changes in invasive strategies and reperfusion practice associated with changes in in-hospital mortality over a 10-year period in patients with acute coronary syndrome?
In a large 10-year multicenter ACS registry, in-hospital mortality remained consistently low (~6.5%) despite progressive population aging, coinciding with widespread adoption of radial access.
Stabilized low ACS mortality despite aging cohort; extends radial access trend data but leaves causal impact open.
Background Management of acute coronary syndrome (ACS) has evolved substantially over the past decade, particularly with widespread adoption of radial access and contemporary mechanical circulatory support (MCS). Whether these changes have translated into sustained improvements in outcomes in an aging population remains uncertain. Purpose To determine whether temporal changes in invasive strategies and reperfusion practice were associated with changes in in-hospital mortality over a 10-year period in a large multicenter ACS registry (K-ACTIVE). Methods We analyzed consecutive ACS patients enrolled between 2015 and 2024 across 58 centers. Temporal trends in patient characteristics, reperfusion metrics, procedural strategies, and in-hospital outcomes were assessed using trend analyses. Results A total of 18,762 patients were included. Over time, patients became significantly older (mean age 68±13 vs. 71±13 years; p for trend <0.01), while the proportion of STEMI remained stable (~75%; p=0.38). Radial access markedly increased from 53% to 86% (p for trend <0.01), and multivessel disease decreased (56% to 44%; p<0.01). Door-to-device time remained stable (median 84 vs. 83 minutes), and the proportion achieving <90 minutes did not substantially improve (~45%; p<0.01), suggesting overall system maturity rather than further temporal shortening. Use of IABP declined (18% to 13%), whereas Impella was introduced after 2020. In-hospital mortality decreased from 9.4% in 2015 to 6.4% in 2016 and remained consistently around 6.5% thereafter (p for overall trend <0.01). When excluding 2015, mortality remained stable without evidence of temporal increase despite progressive aging. Conclusion In this large 58-center registry of 18,762 ACS patients, in-hospital mortality remained consistently low over the past decade despite progressive aging and stable reperfusion metrics. The evolution of invasive strategies—particularly widespread radial adoption—may have contributed to maintaining favorable outcomes in an increasingly complex ACS population.10 year
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Mori et al. (2026) conducted an observational in Acute coronary syndrome (n=18,762). Contemporary ACS invasive management (2016-2024, increased radial access 53% to 86%) vs. Earlier ACS management era (2015) was evaluated on In-hospital mortality (p=<0.01 for overall trend). Evolving ACS management with radial access rising from 53% to 86% saw in-hospital mortality drop from 9.4% in 2015 to ~6.5% through 2024 (p<0.01 for trend).
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