Temporal Trends in Cardiovascular Events After Primary Percutaneous Coronary Intervention for ST-Segment Elevation
Pernille Gro Thrane1, Kevin Kris Warnakula Olesen2, Troels Thim1
1Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark.
Insights
Primary percutaneous coronary intervention (pPCI) significantly reduced major adverse cardiovascular events (MACE) in ST-segment elevation myocardial infarction (STEMI) patients. The 1-year MACE risk dropped by one-third, showing improved outcomes in cardiac care.
Area of Science:
- Cardiology
- Public Health
- Clinical Research
Background:
- Primary percutaneous coronary intervention (pPCI) has been Denmark's standard reperfusion therapy for ST-segment elevation myocardial infarction (STEMI) since 2003.
- Previous findings indicated a decrease in 1-year mortality for pPCI-treated STEMI patients.
- This study investigates the trends in major adverse cardiovascular events (MACE) to understand the causes behind mortality reduction.
Purpose of the Study:
- To analyze trends in the 1-year risk of MACE in STEMI patients treated with pPCI.
- To evaluate changes in MACE risk from 2003 to 2017.
Main Methods:
- Utilized data from the Western Denmark Heart Registry for first-time pPCI-treated STEMI patients (2003-2017).
- Categorized patients into four time periods for analysis: 2003-2006, 2007-2010, 2011-2014, and 2015-2017.
- Defined the primary outcome as 1-year MACE (recurrent myocardial infarction, ischemic stroke, or cardiovascular death) and compared trends with an age- and sex-matched general population.
Main Results:
- Included 18,540 STEMI patients; the 1-year MACE risk decreased from 13.0% (2003-2006) to 8.7% (2015-2017), a statistically significant reduction (adjusted HR: 0.67).
- Individual MACE components also showed similar relative reductions, with cardiovascular death being the most frequent outcome and the primary driver of the absolute MACE reduction.
- The excess 1-year MACE risk in STEMI patients compared to the general population narrowed from 11% to 7% over the study period.
Conclusions:
- A fully implemented pPCI strategy in Western Denmark correlated with a gradual, significant decline in 1-year MACE risk.
- The risk reduction by approximately one-third for MACE and its components highlights improved patient outcomes following pPCI for STEMI.
- These findings underscore the long-term effectiveness of pPCI in managing STEMI and reducing adverse cardiovascular events.
Background:
Primary percutaneous coronary intervention (pPCI) has been the national reperfusion strategy for patients with ST-segment elevation myocardial infarction (STEMI) in Denmark since 2003. We recently reported a gradual reduction in 1-year mortality in patients with pPCI-treated STEMI. To elucidate potential causes of this reduction, we examined trends in major adverse cardiovascular events (MACE).
Objectives:
The purpose of this study was to examine trends in 1-year risk of MACE following pPCI-treated STEMI from 2003 to 2017.
Methods:
The Western Denmark Heart Registry was used to identify first-time PCI-treated patients undergoing pPCI for STEMI from 2003 to 2017. Patients were categorized into 4 time periods (2003-2006, 2007-2010, 2011-2014, and 2015-2017) and the main outcome was 1-year MACE, defined as recurrent myocardial infarction, ischemic stroke, or cardiovascular death. Temporal changes were compared to those of an age- and sex-matched general population.
Results:
We included 18,540 first-time pPCI-treated STEMI patients between 2003 and 2017. The 1-year risk of MACE decreased from 13.0% in 2003-2006 to 8.7% in 2015-2017 (adjusted HR: 0.67; 95% CI: 0.58-0.76). Similar relative reductions were observed for the individual components of MACE. Cardiovascular death was the most common outcome and the largest contributor to the absolute reduction in MACE. Compared to the matched general population, STEMI patients had 11% higher 1-year risk of MACE in 2003 to 2006, a risk difference that decreased to 7% in 2015 to 2017.
Conclusions:
In Western Denmark, with a fully implemented pPCI strategy, the 1-year risk of MACE and its individual components declined gradually by one-third in pPCI-treated STEMI patients from 2003 to 2017.
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