Trends in Short- and Long-Term ST-Segment-Elevation Myocardial Infarction Prognosis Over 3 Decades: A Mediterranean
Cosme García-García1,2, Teresa Oliveras1, Jordi Serra1
1Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain.
Journal of the American Heart Association
|October 15, 2020
Summary
Outcomes for ST-segment-elevation myocardial infarction (STEMI) have significantly improved over 30 years, with reduced mortality and fewer in-hospital complications. However, reducing primary ventricular fibrillation remains a critical challenge in STEMI care.
Area of Science:
- Cardiology
- Public Health
- Clinical Research
Background:
- Coronary artery disease is a leading cause of death.
- ST-segment-elevation myocardial infarction (STEMI) outcomes have improved, but prognosis requires ongoing analysis.
- Long-term trends in STEMI prognosis are crucial for understanding disease management evolution.
Purpose of the Study:
- To analyze in-hospital, 28-day, and 1-year outcomes for STEMI patients.
- To assess temporal trends in STEMI prognosis over three decades using registry data.
- To identify improvements and persistent challenges in STEMI management.
Main Methods:
- Analysis of 7589 consecutive STEMI patients from the Ruti-STEMI registry (1989-2017).
- Patients were stratified into five distinct time periods.
- Cox regression was used to compare mortality and complication trends across periods.
Main Results:
- A significant decline in 28-day mortality (10.4% to 6.0%) and 1-year mortality (11.7% to 9.0%) was observed.
- Multivariable analysis showed a 40% reduction in 28-day mortality and 24% in 1-year mortality.
- In-hospital complications like postinfarct angina, ventricular tachycardia, and pericarditis decreased significantly; primary ventricular fibrillation showed no significant trend.
Conclusions:
- STEMI in-hospital complications and mortality rates (28-day and 1-year) have markedly decreased over the past 30 years.
- Significant improvements in STEMI prognosis are evident.
- Reducing ischemia-driven primary ventricular fibrillation remains a key challenge in STEMI management.
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