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Associations of changes in patient characteristics and management with decrease in mortality rates of men and women
Lukasz Zandecki1,2, Marianna Janion1,2, Marcin Sadowski2,3
12 Cardiology Clinic, Swietokrzyskie Cardiology Center, Kielce, Poland.
Insights
Improved treatment strategies and patient characteristics significantly reduced myocardial infarction (STEMI) mortality. Women experienced greater benefits due to favorable baseline risk profile changes, highlighting the importance of modifiable factors.
Area of Science:
- Cardiology
- Public Health
- Clinical Medicine
Background:
- Myocardial infarction with ST-segment elevation (STEMI) remains a significant cause of mortality.
- Recent years have seen advancements in treatment strategies for STEMI patients.
- Understanding the drivers of mortality reduction is crucial for optimizing patient outcomes.
Purpose of the Study:
- To quantify the impact of improved treatment strategies on STEMI mortality.
- To assess the contribution of changing baseline patient characteristics to STEMI mortality trends.
- To compare these effects between men and women.
Main Methods:
- Retrospective analysis of 32,790 STEMI patients from the Polish Registry of Acute Coronary Syndromes (PL-ACS).
- Data collected from hospitalizations in 2005 and 2011.
- Analysis of treatment strategy changes and propensity score matching to compare mortality rates.
Main Results:
- Significant improvements in STEMI management observed between 2005 and 2011, including increased use of percutaneous coronary interventions and guideline-based therapies.
- A notable decrease in in-hospital mortality was associated with these treatment advancements.
- While 12-month mortality reduction was less pronounced, it was more influenced by changes in patient characteristics, with women showing greater risk reduction due to improved baseline profiles.
Conclusions:
- Enhanced treatment strategies have contributed to improved survival rates in STEMI patients.
- Shifting patient clinical characteristics also play a vital role, particularly in women.
- Future efforts should focus on modifiable risk factors and post-discharge care to sustain and extend survival benefits.
Introduction:
The aim of this study is to estimate how much of the recent decrease in mortality among patients with myocardial infarction with ST-segment elevation (STEMI) can be attributed to improved treatment strategies, and how much it is related to changes in baseline clinical characteristics, and to compare these findings for men and women.
Material And Methods:
This was a retrospective analysis of 32,790 patients with STEMI from the Polish Registry of Acute Coronary Syndromes PL-ACS hospitalised in 2005 and 2011. Changes in treatment strategies including pharmacotherapy were analysed. Observed in-hospital and 12-month mortality rates were compared with the outcomes in the groups matched on the propensity scores.
Results:
There was a substantial improvement in STEMI patient management between 2005 and 2011 in Poland. It included greater use of percutaneous coronary interventions and other guideline-based adjunctive therapies, and it was associated with a significant decline in in-hospital mortality. Relative 12-month mortality reduction rates were less pronounced and more related to changes in patients' clinical characteristics. Higher mortality risk reductions were observed in women and were driven by relatively more positive changes in their baseline risk profiles when compared to men.
Conclusions:
The progress in the treatment strategies has helped to achieve better survival rates in STEMI patients. However, the ongoing changes in clinical characteristics of patients also played an important role, especially in women. Clinicians should focus on modifiable risk factors and post-discharge management to possibly prolong the positive aspects of in-hospital efforts.
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