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. 2023 Sep 5;82(10):999-1010.
doi: 10.1016/j.jacc.2023.06.025.

Mortality Trends After Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction

Pernille Gro Thrane  1 , Kevin Kris Warnakula Olesen  2 , Troels Thim  3 , Christine Gyldenkerne  2 , Martin Bødtker Mortensen  2 , Steen Dalby Kristensen  3 , Michael Maeng  4
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Free article

Mortality Trends After Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction

Pernille Gro Thrane et al. J Am Coll Cardiol. .
Free article

Abstract

Background: Observational studies have reported that mortality rates after ST-segment elevation myocardial infarction (STEMI) have been stable since 2006 to 2010.

Objectives: The aim of this study was to evaluate the temporal trends in 1-year, 30-day, and 31- to 365-day mortality after STEMI in Western Denmark where primary percutaneous coronary intervention (PCI) has been the national reperfusion strategy since 2003.

Methods: Using the Western Denmark Heart Registry, the study identified first-time PCI-treated patients undergoing primary PCI (pPCI) for STEMI from 2003 to 2018. Based on the year of pPCI, patients were divided into 4 time-interval groups and followed up for 1 year using the Danish national health registries.

Results: A total of 19,613 patients were included. Median age was 64 years, and 74% were male. One-year mortality decreased gradually from 10.8% in 2003-2006, 10.4% in 2007-2010, 9.1% in 2011-2014, to 7.7% in 2015-2018 (2015-2018 vs 2003-2006: adjusted HR [aHR]: 0.71; 95% CI: 0.62-0.82). The largest absolute mortality decline occurred in the 0- to 30-day period with a 2.3% reduction (aHR: 0.69; 95% CI: 0.59-0.82), and to a lesser extent in the 31- to 365-day period (risk reduction: 1.0%; aHR: 0.71; 95% CI: 0.56-0.90).

Conclusions: In a high-income European country with a fully implemented pPCI strategy, 1-year mortality in pPCI-treated patients with STEMI decreased substantially between 2003 and 2018. Approximately three-quarters of the absolute mortality reduction occurred within the first 30 days after pPCI. These results indicate that optimization of early management of pPCI-treated patients with STEMI offers great opportunities for improving overall survival in contemporary clinical practice.

Keywords: myocardial infarction; prognosis; registry; reperfusion; time trends.

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Conflict of interest statement

Funding Support and Author Disclosures The study was supported by a grant from the Aase and Ejnar Danielsen Foundation. Dr Olesen is supported by a grant from the Danish Cardiovascular Academy funded by the Danish Heart Association and Novo Nordisk. Dr Kristensen is national coordinating investigator in the SOS-AMI (Selatogrel Outcome Study in Suspected Acute Myocardial Infarction) trial (Idorsia). Dr Mortensen has received lecture fees from Novo Nordisk, Amgen, Sanofi, AstraZeneca, and Amarin. Dr Maeng is supported by a grant from the Novo Nordisk Foundation (grant NNF22OC0074083); has received institutional research grants from Novo Nordisk and Bayer; and has received lecture and/or advisory board fees from AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, and Novo Nordisk. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Comment in

  • STEMI-Related Mortality: Don't Stop Believin'.
    Henry TD, Baron SJ, Jacobs AK. Henry TD, et al. J Am Coll Cardiol. 2023 Sep 5;82(10):1011-1013. doi: 10.1016/j.jacc.2023.07.007. J Am Coll Cardiol. 2023. PMID: 37648351 No abstract available.

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