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

Mouse studies shed light on how protein controls heart failure

October 18, 2017
A new study on two specially bred strains of mice has illuminated how abnormal addition of the chemical phosphate to a specific heart muscle protein may sabotage the way the protein behaves in a cell, and may damage the way ...

Newborns with trisomy 13 or 18 benefit from heart surgery, study finds

October 18, 2017
Heart surgery significantly decreases in-hospital mortality among infants with either of two genetic disorders that cause severe physical and intellectual disabilities, according to a new study by a researcher at the Stanford ...

Saving hearts after heart attacks: Overexpression of a gene enhances repair of dead muscle

October 17, 2017
University of Alabama at Birmingham biomedical engineers report a significant advance in efforts to repair a damaged heart after a heart attack, using grafted heart-muscle cells to create a repair patch. The key was overexpressing ...

High blood pressure linked to common heart valve disorder

October 17, 2017
For the first time, a strong link has been established between high blood pressure and the most common heart valve disorder in high-income countries, by new research from The George Institute for Global Health at the University ...

Blood cancer gene could be key to preventing heart failure

October 16, 2017
A new study, published today in Circulation, shows that the gene Runx1 increases in damaged heart muscle after a heart attack. An international collaboration led by researchers from the University of Glasgow, found that mice ...

Mitochondrial DNA could predict risk for sudden cardiac death, heart disease

October 11, 2017
Johns Hopkins researchers report that the level, or "copy number," of mitochondrial DNA—genetic information stored not in a cell's nucleus but in the body's energy-creating mitochondria—is a novel and distinct biomarker ...

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.