Elsevier

American Heart Journal

Volume 214, August 2019, Pages 97-106
American Heart Journal

Clinical Investigation
Twenty-year trends in profile, management and outcomes of patients with ST-segment elevation myocardial infarction according to use of reperfusion therapy: Data from the FAST-MI program 1995-2015

https://doi.org/10.1016/j.ahj.2019.05.007Get rights and content

Background

The increased use of reperfusion therapy in ST-segment-elevation myocardial infarction (STEMI) patients in the past decades is generally considered the main determinant of improved outcomes. The aim was to assess 20-year trends in profile, management, and one-year outcomes in STEMI patients in relation with use or non-use of reperfusion therapy (primary percutaneous coronary intervention (pPCI) or fibrinolysis).

Methods

We used data from 5 one-month French nationwide registries, conducted 5 years apart from 2005 to 2015, including 8579 STEMI patients (67% with and 33% without reperfusion therapy) admitted to cardiac intensive care units in France.

Results

Use of reperfusion therapy increased from 49% in 1995 to 82% in 2015, with a shift from fibrinolysis (37.5% to 6%) to pPCI (12% to 76%). Early use of evidence-based medications gradually increased over the period in both patients with and without reperfusion therapy, although it remained lower at all times in those without reperfusion therapy. One-year mortality decreased in patients with reperfusion therapy (from 11.9% in 1995 to 5.9% in 2010 and 2015, hazard ratio [HR] adjusted on baseline profile 0.40; 95% CI: 0.29-0.54, P < .001) and in those without reperfusion therapy (from 25.0% to 18.2% in 2010 and 8.1% in 2015, HR: 0.33; 95% CI: 0.24-0.47, P < .001).

Conclusions

In STEMI patients, one-year mortality continues to decline, both related to increased use of reperfusion therapy and progress in overall patient management. In patients with reperfusion therapy, mortality has remained stable since 2010, while it has continued to decline in patients without reperfusion therapy.

Section snippets

Patient population

Five nationwide French registries were conducted 5 years apart over a 20-year period (1995-2015): USIK 1995, 11 USIC (Unité de Soins Intensifs Coronaires) 2000,12 FAST-MI (French Registry of Acute ST-Elevation or non-ST-elevation Myocardial Infarction) 2005 (NCT00673036),13 FAST-MI 2010 (NCT01237418),14 and FAST-MI 2015 (NCT02566200)15 (eMethods 1). The methods used for these registries have been detailed previously.11., 12., 13., 14., 15. Briefly, their primary objectives were to evaluate the

Study population

Among the 8579 STEMI patients enrolled in the 5 surveys, the use of any reperfusion therapy (pPCI or fibrinolysis) increased consistently over the 20-year period (P < .001; Figure 1). Patient with reperfusion therapy were younger, and had a lower cardiovascular risk profile, both in terms of risk factors and history of cardiovascular disease (Table 1, Table 2). Women received less reperfusion therapy compared to men for each survey (P < .001; eTable 1). Finally, current smoking was more

Discussion

In patients with STEMI, the use of reperfusion therapy has increased by more than 50% over the past 20 years. At the same time, the profile of patients has changed, with opposite trends in those with or without reperfusion therapy: patients with reperfusion therapy at the end of 2015 were 1 year older and with shorter times from symptom onset to admission, while patients without reperfusion therapy were younger, and with longer times to admission, compared to 1995. Evidence-based treatments at

Conclusions

In STEMI patients, one-year mortality has considerably declined from 1995 to 2015, both related to increased use of reperfusion therapy but also to progress in overall patient management, as evidenced by the continuous decrease in mortality also found in patients without reperfusion therapy. In patients with reperfusion therapy, mortality has reached a plateau since 2010, while it has continued to decline in patients without reperfusion therapy. Our study suggests that the margin for

Acknowledgements

The authors are deeply indebted to all patients who accepted to participate in the surveys, and to the physicians who took care of the patients at the participating institutions.

Funding

The French Society of Cardiology received grants for supporting the FAST-MI program from Amgen, AstraZeneca, Bayer, BMS, Boehringer-Ingelheim, Daiichi Sankyo, Eli Lilly, MSD, Pfizer, and Sanofi. None of the companies had a role in the design and conduct of the study, data collection and management. They were not involved in the analysis and interpretation of the data, nor in the preparation, review, or approval of the manuscript.

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