TY - JOUR
T1 - Temporal changes in patient characteristics and outcomes in ST-segment elevation myocardial infarction 2003–2018
AU - Garcia, Santiago
AU - Schmidt, Christian W.
AU - Garberich, Ross
AU - Henry, Timothy D.
AU - Bradley, Steven M.
AU - Brilakis, Emmanouil S.
AU - Burke, Nickolas
AU - Chavez, Ivan J.
AU - Eckman, Peter
AU - Gössl, Mario
AU - Mooney, Michael R.
AU - Newell, Marc C.
AU - Poulose, Anil K.
AU - Sorajja, Paul
AU - Traverse, Jay H.
AU - Wang, Yale L.
AU - Sharkey, Scott W.
N1 - Funding Information:
Mario Gössl: Abbott Vascular: consulting; Edwards Lifesciences: research grants. Paul Sorajja: Edwards Lifesciences: research grants, consulting, speaking; Boston Scientific: research grants, consulting, speaking; Medtronic: research grants, consulting, speaking; Abbott Structural: research grants, consulting, speaking; Admedus, equity and consulting; Gore, consulting; Cardionomics, consulting Santiago Garcia: Edwards Lifesciences, Medtronic and Abbott Vascular, consulting. American College of Cardiology: Compensation. Emmanouil Brilkais: Consulting and speaking honoraria from Abbott Vascular, Asahi, Boston Scientific, Elsevier, Somahlution, St. Jude Medical, and Terumo; and has received research support from InfraRedx and Boston Scientific. The other authors have nothing to disclose related to this manuscript.
Publisher Copyright:
© 2020 Wiley Periodicals LLC.
PY - 2021/5/1
Y1 - 2021/5/1
N2 - Background: We sought to describe changes in demographic variables, process of care measures, and outcomes of patients treated in a regional ST-segment elevation myocardial infarction (STEMI) program over the last 15 years. Methods: We describe demographic variables, process of care measures, and outcomes of patients treated in the program in various 5-year time periods: 2003–2007 (n = 1,821), 2008–2012 (n = 1,968), and 2013–2018 (n = 2,223). The primary outcome measures were in-hospital and 30-day mortality. Results: Among 6,012 STEMI patients treated from 2003 to 2018 we observed a significant increase in mean age at presentation (62 ± 14 to 64 ± 13 years) and diabetes (14–22%, p <.01). The proportion of patients with cardiogenic shock (CS) and cardiac arrest (CA) pre-PCI increased significantly from 9.5% to 11.1% and 8.5% to 12.7% (p <.05), respectively. The median door-to-balloon (D2B) times decreased from 98 to 93 min and total ischemic time decreased from 202 to 185 min (all p <.05). Despite increased patient complexity, the proportion of nontransfer and transfer patients achieving D2B times consistent with guideline recommendations remained unchanged (for nontransfer patients 79–82%, p =.45 and for transfer patients 65–64%, p =.34). Among all STEMI patients, in-hospital mortality increased during the study period from 4.9 to 6.9% (p =.007) but remained stable (<2%) when CA and CS patients were excluded. Conclusions: Over the last 15 years, short-term STEMI mortality has increased despite improvements in care delivery metrics. Patients with CA and/or CS now represent 10% of STEMI patients and are responsible for 80% of deaths. Therefore, efforts to improve STEMI mortality, and metrics for assessing STEMI programs, should focus on these patients.
AB - Background: We sought to describe changes in demographic variables, process of care measures, and outcomes of patients treated in a regional ST-segment elevation myocardial infarction (STEMI) program over the last 15 years. Methods: We describe demographic variables, process of care measures, and outcomes of patients treated in the program in various 5-year time periods: 2003–2007 (n = 1,821), 2008–2012 (n = 1,968), and 2013–2018 (n = 2,223). The primary outcome measures were in-hospital and 30-day mortality. Results: Among 6,012 STEMI patients treated from 2003 to 2018 we observed a significant increase in mean age at presentation (62 ± 14 to 64 ± 13 years) and diabetes (14–22%, p <.01). The proportion of patients with cardiogenic shock (CS) and cardiac arrest (CA) pre-PCI increased significantly from 9.5% to 11.1% and 8.5% to 12.7% (p <.05), respectively. The median door-to-balloon (D2B) times decreased from 98 to 93 min and total ischemic time decreased from 202 to 185 min (all p <.05). Despite increased patient complexity, the proportion of nontransfer and transfer patients achieving D2B times consistent with guideline recommendations remained unchanged (for nontransfer patients 79–82%, p =.45 and for transfer patients 65–64%, p =.34). Among all STEMI patients, in-hospital mortality increased during the study period from 4.9 to 6.9% (p =.007) but remained stable (<2%) when CA and CS patients were excluded. Conclusions: Over the last 15 years, short-term STEMI mortality has increased despite improvements in care delivery metrics. Patients with CA and/or CS now represent 10% of STEMI patients and are responsible for 80% of deaths. Therefore, efforts to improve STEMI mortality, and metrics for assessing STEMI programs, should focus on these patients.
KW - acute myocardial infarction
KW - outcomes
KW - trends
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U2 - 10.1002/ccd.28901
DO - 10.1002/ccd.28901
M3 - Article
C2 - 32294799
AN - SCOPUS:85083450425
SN - 1522-1946
VL - 97
SP - 1109
EP - 1117
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 6
ER -