Significant decrease in in-hospital mortality and major adverse cardiac events in Swiss STEMI patients between 2000
Valérie Stolt Steiger1, Jean-Jacques Goy, Jean-Christophe Stauffer
1Division of Cardiology, Hôpital Cantonal, Fribourg, Switzerland. valerie.stolt@turnover.ch
Insights
In-hospital mortality and reinfarction rates for ST elevation myocardial infarction (STEMI) patients in Switzerland significantly decreased between 2000 and 2007. This improvement is strongly linked to increased access to percutaneous coronary interventions (PCI).
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- ST elevation myocardial infarction (STEMI) remains a critical cardiovascular condition requiring effective in-hospital management.
- Understanding trends in STEMI outcomes and identifying key predictors is crucial for improving patient care.
- The period 2000-2007 saw significant advancements in cardiovascular interventions, particularly percutaneous coronary intervention (PCI).
Purpose of the Study:
- To evaluate the in-hospital outcomes for STEMI patients in Switzerland from 2000 to 2007.
- To identify predictors of in-hospital mortality and major adverse cardiac events in this patient cohort.
- To assess the impact of evolving treatment strategies, such as PCI, on STEMI outcomes.
Main Methods:
- Analysis of data from the Swiss national registry AMIS Plus (Acute Myocardial Infarction and Unstable Angina in Switzerland).
- Inclusion of 12,026 patients diagnosed with STEMI or new left bundle branch block (LBBB) between January 2000 and December 2007.
- Statistical evaluation of in-hospital mortality, reinfarction rates, and treatment modalities, including PCI and thrombolysis.
Main Results:
- In-hospital mortality decreased from 7.6% in 2000 to 6% in 2007; reinfarction rates fell from 3.7% to 0.9%.
- Percutaneous coronary intervention (PCI) use increased from 43% to 85%, with PCI patients exhibiting significantly lower mortality (3.9% vs. 11.2%) and reinfarction rates (1.1% vs. 3.1%).
- Key predictors of mortality included older age (>65), Killip class III/IV, diabetes, and Q-wave myocardial infarction; PCI access was the strongest predictor of survival.
Conclusions:
- Significant reductions in in-hospital mortality and reinfarction were observed in Swiss STEMI patients over a seven-year period.
- The increase in percutaneous coronary interventions (PCI) alongside medical therapy was strongly associated with these improved outcomes.
- Access to PCI facilities, rather than the specific hospital of admission, emerged as a critical determinant of patient survival.
Objectives:
To evaluate the in-hospital outcome of STEMI (ST elevation myocardial infarction) patients admitted to Swiss hospitals between 2000 and December 2007, and to identify the predictors of in-hospital mortality and major cardiac events.
Methods:
Data from the Swiss national registry AMIS Plus (Acute Myocardial Infarction and Unstable Angina in Switzerland) were used. All patients admitted between January 2000 and December 2007 with STEMI or a new LBBB (left bundle branch block) were included in the registry.
Result:
We studied 12 026 STEMI patients admitted to 68 hospitals. The mean age was 64 +/- 13 years and 73% of the patients were male. Incidence of in-hospital death was 7.6% in 2000 and 6% in 2007. Reinfarction fell from 3.7% in 2000 to 0.9% in 2007. Thrombolysis decreased from 40.2% in 2000 to 2% in 2007. Clinical predictors of mortality were: age >65 years, Killips class III or IV, diabetes, Q wave myocardial infarction (at presentation). Patients undergoing percutaneous coronary intervention (PCI) had lower mortality and reinfarction rates (3.9% versus 11.2% and 1.1% versus 3.1% respectively, p <0.001) over time, although their numbers increased from 43% in 2000 to 85% in 2007. Patients admitted to hospitals with PCI facilities had lower mortality than patients hospitalised in hospitals without it, but the demographic characteristics differ widely between the two groups. Both in-hospital mortality and reinfarction decreased significantly over the time, parallel to an increased number of PCI. PCI was also the strongest predictor of survival.
Conclusion:
In-hospital mortality and reinfarction rate have decreased significantly in Swiss STEMI patients in the last seven years, parallel to a significant increase in the number of percutaneous coronary interventions in addition to medical therapy. Outcome is not related to the site of admission but to PCI access.
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