10-Year Mortality After ST-Segment Elevation Myocardial Infarction Compared to the General Population
Pernille Gro Thrane1, Kevin Kris Warnakula Olesen1, Troels Thim1
1Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Insights
Patients surviving ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PCI) have only a 2% excess mortality over 10 years. This indicates favorable long-term outcomes for STEMI survivors with optimal treatment.
Area of Science:
- Cardiology
- Public Health
- Clinical Medicine
Background:
- ST-segment elevation myocardial infarction (STEMI) is a critical condition with significant early mortality.
- Long-term survival and excess mortality in STEMI patients after initial treatment remain incompletely understood.
Purpose of the Study:
- To evaluate the long-term excess mortality in STEMI patients treated with primary percutaneous coronary intervention (PCI).
- To compare mortality rates at landmark periods (0-30 days, 31-90 days, 91 days to 10 years) against an age- and sex-matched general population.
Main Methods:
- Utilized the Western Denmark Heart Registry to identify 18,818 first-time STEMI patients undergoing primary PCI (2003-2018).
- Matched each STEMI patient with 5 individuals from the general population based on age and sex.
- Analyzed mortality data at 0-30 days, 31-90 days, and 91 days to 10 years post-PCI.
Main Results:
- STEMI was associated with a 5.9% excess mortality in the first 30 days and 0.9% from 31-90 days.
- In STEMI survivors at 90 days, the 10-year excess mortality was only 2.1 percentage points (26.5% vs. 24.5%).
- High adherence to secondary preventive medications (statins, antiplatelet therapy, beta-blockers) was observed throughout the follow-up period.
Conclusions:
- STEMI patients treated with primary PCI who survive the initial 90 days experience only a modest increase in long-term mortality.
- The 10-year excess mortality for these survivors is approximately 2% compared to the general population.
- High utilization of guideline-recommended secondary preventive therapies contributes to favorable long-term outcomes in STEMI survivors.
Background:
ST-segment elevation myocardial infarction (STEMI) is associated with high early mortality. However, it remains unclear if patients surviving the early phase have long-term excess mortality.
Objectives:
This study aims to assess excess mortality in STEMI patients treated with primary percutaneous coronary intervention (PCI) compared with an age- and- sex-matched general population at landmark periods 0 to 30 days, 31 to 90 days, and 91 days to 10 years.
Methods:
Using the Western Denmark Heart Registry, we identified first-time PCI-treated patients who had primary PCI for STEMI from January 2003 to October 2018. Each patient was matched by age and sex to 5 individuals from the general population.
Results:
We included 18,818 patients with first-time STEMI and 94,090 individuals from the general population. Baseline comorbidity burden was similar in STEMI patients and matched individuals. Compared with the matched individuals, STEMI was associated with a 5.9% excess mortality from 0 to 30 days (6.0% vs 0.2%; HR: 36.44; 95% CI: 30.86-43.04). An excess mortality remained present from 31 to 90 days (0.9% vs 0.4%; HR: 2.43; 95% CI: 2.02-2.93). However, in 90-day STEMI survivors, the absolute excess mortality was only 2.1 percentage points at 10-year follow-up (26.5% vs 24.5%; HR: 1.04; 95% CI: 1.01-1.08). Use of secondary preventive medications such as statins, antiplatelet therapy, and beta-blockers was very high in STEMI patients throughout 10-year follow-up.
Conclusions:
In primary PCI-treated STEMI patients with high use of guideline-recommended therapy, patients surviving the first 90 days had 10-year mortality that was only 2% higher than that of a matched general population.
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