Clinical InvestigationTwenty-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
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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