Transforming post-STEMI care: The IMPACS study design and baseline patient profile

Despite major advances in the acute management of ST-segment elevation myocardial infarction (STEMI), long-term outcomes remain suboptimal, largely due to persistent gaps in secondary prevention. The IMPACS study was designed to evaluate a standardized, intensified outpatient management strategy during the first year following STEMI.

IMPACS is a national, prospective, multicentre study comparing an intensified outpatient disease-management program with standard care. Consecutive STEMI patients were enrolled at four PCI centres. The intervention includes four structured outpatient visits within one year of discharge, focusing on clinical assessment, pharmacotherapy optimisation, and comprehensive risk-factor management. The primary endpoint is a composite of all-cause mortality and cardiovascular hospitalisations, compared with matched administrative-data controls from the six remaining PCI centres nationwide.

A total of 1031 patients were included. The mean age was 62 years, and 75% were male. Primary PCI was performed in 96% of patients. Anterior-wall STEMI occurred in 43%, and 6% presented with advanced Killip class (III or IV). The median left ventricular ejection fraction was 45%. Cardiovascular risk factors were highly prevalent: hypertension in 73%, high LDL-C in 75%, diabetes mellitus in 23%, and current smoking in 49%. Prescription of guideline-directed medical therapy at discharge was high, with dual antiplatelet therapy in 95% and statins in 99% of patients.

IMPACS represents a novel approach to post-ACS care. Baseline findings indicate a relatively young STEMI population with a high burden of cardiovascular risk factors, supporting the need for intensified secondary prevention strategies. Ongoing follow-up will determine its impact on long-term clinical outcomes.