Decrease in early mortality in STEMI attributed to changing patient profile and behavior

August 27, 2012

Data from four French nationwide registries of STEMI (ST-elevation myocardial infarction) patients initiated five years apart and covering more than 15 years show that mortality rate decreased by 68% over this period, from 13.7% to 4.4%. Around one quarter of this mortality reduction could be attributed to a change in patient characteristics.

Even after adjusting for the use of primary (PCI) and reperfusion therapy, there still remained a substantial decrease in early mortality rate (>60%), underlining the importance of population characteristics, patient behaviour and the general organisation and provision of care. Even in not having reperfusion therapy, STEMI mortality rate decreased by more than 50%.

The results were presented here in Munich by Dr Nicolas Danchin representing the French registries USIK 1995, USIC 2000, FAST-MI 2005 and FAST-MI 2010.

Explaining the purpose of the combined analysis, Dr Danchin said: "Spectacular progress has been made in the treatment of ST-elevation . Most of this progress is generally attributed to the more frequent administration of reperfusion therapy, particularly by primary PCI. Using data from these four STEMI registries, we sought to determine the extent of improvement in survival, and whether factors other than reperfusion therapy contributed to the decline in early mortality."

The analysis did indeed show a notable change in population characteristics: a progressive three-year average decease in age, and a lower proportion of patients with associated conditions or previously known . This was mainly explained by a substantial increase in the proportion of younger patients (ie, below 60 years of age), especially women; the proportion of women under 60 years of age doubled (from 12% to 25%), and that of women under 50 years tripled (from 3.7% to 11.1%).

A fast growing proportion of were current (37% in 1995, 73% in 2010) and/or obese (18% to 27%).

The behaviour of patients confronted with acute chest pain also changed, with a more rapid call for medical help (from a median of 120 minutes in 2000 to 74 minutes in 2010). Similarly, more patients called the emergency medical system (SAMU in France) - 23% in 2000 and 49% in 2010.

More patients also received reperfusion therapy to reopen the blocked artery - 75% in 2010, compared with 49% in 1995, with a five-fold increase in use of primary PCI (from 12% to 60%).

Other changes were observed in the early management of STEMI patients, with more receiving antiplatelet agents or low molecular weight heparin to help dissolve the clot, as well as other recommended medications (particularly statins, whose use increased from 10% to 90%).

"Overall," said Dr Danchin, "the major decline in early mortality for STEMI patients should not be attributed only to improved delivery of reperfusion treatment. The improvement also reflects a profound and preoccupying change in the type of patient having a heart attack, with a particular increase in the number of young women. This increase is concomitant with an increased prevalence of smoking and obesity."

"The successes achieved in older patients and the changes in patient profile suggest that, to reduce the rate of STEMI mortality even further, future efforts should be directed at making healthcare providers and the general public more aware of the growing proportion of younger females among STEMI patients. Future preventive measures might be specifically targeted towards this group."

Explore further: Study examines factors associated with improvement in survival from heart attack in France

Related Stories

Study examines factors associated with improvement in survival from heart attack in France

August 27, 2012
The overall rate of death in patients hospitalized with ST-segment elevation myocardial infarction (STEMI; a certain pattern on an electrocardiogram following a heart attack) decreased from 1995 to 2010 in France, with possible ...

Multiple factors motivate no reperfusion in STEMI

August 2, 2012
(HealthDay) -- For patients presenting with ST-segment elevation myocardial infarction (STEMI), the decision for no reperfusion is usually multifactorial, with the most common factor being advanced age, according to a study ...

Most heart-attack patients needing procedure at another hospital not transferred in recommended time

June 21, 2011
Only about 10 percent of patients with a certain type of heart attack who need to be transferred to another hospital for a PCI (procedures such as balloon angioplasty or stent placement used to open narrowed coronary arteries) ...

Time trends in STEMI -- improved treatment and outcome but gender gap persists

August 29, 2011
In spite of an increased attention to gender differences in treatment of myocardial infarctions, focus on adherence to guidelines and a change in predominant therapy, the gender difference in treatment and mortality regarding ...

Some 90-year-old heart attack patients have 'excellent' outcomes with coronary stenting

March 25, 2012
Selected patients 90 years and older who experience an acute heart attack, or ST-elevation myocardial infarction (STEMI), have reasonable outcomes with coronary stenting, and should be considered for reperfusion therapy, ...

Recommended for you

Researchers investigate the potential of spider silk protein for engineering artificial heart

August 18, 2017
Ever more people are suffering from cardiac insufficiency, despite significant advances in preventing and minimising damage to the heart. The main cause of reduced cardiac functionality lies in the irreversible loss of cardiac ...

Lasers used to detect risk of heart attack and stroke

August 18, 2017
Patients at risk of heart attacks and strokes may be spotted earlier thanks to a diagnosis tool that uses near-infrared light to identify high-risk arterial plaques, according to research carried out at WMG, University of ...

How Gata4 helps mend a broken heart

August 15, 2017
During a heart attack, blood stops flowing into the heart; starved for oxygen, part of the heart muscle dies. The heart muscle does not regenerate; instead it replaces dead tissue with scars made of cells called fibroblasts ...

Injectable tissue patch could help repair damaged organs

August 14, 2017
A team of U of T Engineering researchers is mending broken hearts with an expanding tissue bandage a little smaller than a postage stamp.

'Fat but fit' are at increased risk of heart disease

August 14, 2017
Carrying extra weight could raise your risk of heart attack by more than a quarter, even if you are otherwise healthy.

Air pollution linked to cardiovascular disease; air purifiers may lessen impact

August 14, 2017
Exposure to high levels of air pollution increased stress hormone levels and negative metabolic changes in otherwise healthy, young adults in a recent study conducted in China. Air purifiers appeared to lessen the negative ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.