Temporal trends in latecomer STEMI patients: insights from the AMIS Plus registry 1997-2017
Marco Roberto1, Dragana Radovanovic2, Edoardo de Benedetti3
1Servizio di Cardiologia, Cardiocentro Ticino, Lugano, Switzerland.
Insights
Late presentation of ST-segment elevation myocardial infarction (STEMI) decreased significantly over 20 years. Improved treatments, including percutaneous coronary intervention (PCI), reduced in-hospital mortality in these patients.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Late presentation of ST-segment elevation myocardial infarction (STEMI) is common, yet temporal trends in large real-world settings are understudied.
- Understanding trends in STEMI patient-related delay is crucial for improving outcomes.
Purpose of the Study:
- To analyze temporal trends in late presentation of STEMI patients.
- To assess changes in treatment patterns and in-hospital mortality among STEMI patients with delayed presentation over a 20-year period.
Main Methods:
- A retrospective analysis of 27,231 STEMI patients from the AMIS Plus registry (1997-2017).
- Patients were classified as early (≤12 hours) or late (>12 hours) presenters based on patient-related delay.
- Trends in treatment (P2Y12 inhibitors, PCI) and in-hospital mortality were evaluated.
Main Results:
- The prevalence of late STEMI presentation decreased from 22% to 12.3% over the study period (P <.001).
- Evidence-based pharmacological treatments and percutaneous coronary intervention (PCI) rates significantly increased among late presenters.
- In-hospital mortality in late STEMI patients dropped from 12.4% to 4.5% (P <.001).
Conclusions:
- Over two decades, late STEMI presentation became less common, with increased use of guideline-directed medical therapy and PCI.
- The substantial reduction in in-hospital mortality, particularly in patients presenting 12-48 hours late, was strongly associated with the rise in PCI utilization.
Introduction And Objectives:
A substantial proportion of patients experiencing ST-segment elevation myocardial infarction (STEMI) have a late presentation. There is a lack of temporal trends drawn from large real-word scenarios in these patients.
Methods:
All STEMI patients included in the AMIS Plus registry from January 1997 to December 2017 were screened and patient-related delay was assessed. STEMI patients were classified as early or latecomers according to patient-related delay (≤ or> 12hours, respectively).
Results:
A total of 27 231 STEMI patients were available for the analysis. During the study period, the prevalence of late presentation decreased from 22% to 12.3% (P <.001). In latecomer STEMI patients, there was a gradual uptake of evidence-based pharmacological treatments (rate of P2Y12 inhibitors at discharge, from 6% to 90.6%, P <.001) and a marked increase in the use of percutaneous coronary intervention (PCI), particularly in 12- to 48-hour latecomers (from 11.9%-87.9%; P <.001). In-hospital mortality was reduced from 12.4% to 4.5% (P <.001). On multivariate analysis, PCI had a strong independent protective effect on in-hospital mortality in 12- to 48-hour latecomers (OR, 0.29; 95%CI, 0.15-0.55).
Conclusions:
During the 20-year study period, there was a progressive reduction in the prevalence of late presentation, a gradual uptake of main evidence-based pharmacological treatments, and a marked increase in PCI rate in latecomer STEMI patients. In-hospital mortality was reduced to a third (to an absolute rate of 4.5%); in 12- to 48-hour latecomers, this reduction seemed to be mainly associated with the increasing implementation of PCI.
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