Temporal changes in patient characteristics and outcomes in ST-segment elevation myocardial infarction 2003–2018

Santiago Garcia, Christian W. Schmidt, Ross Garberich, Timothy D. Henry, Steven M. Bradley, Emmanouil S. Brilakis, Nickolas Burke, Ivan J. Chavez, Peter Eckman, Mario Gössl, Michael R. Mooney, Marc C. Newell, Anil K. Poulose, Paul Sorajja, Jay H. Traverse, Yale L. Wang, Scott W. Sharkey

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

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.

Original languageEnglish (US)
JournalCatheterization and Cardiovascular Interventions
DOIs
StateAccepted/In press - Jan 1 2020
Externally publishedYes

Keywords

  • acute myocardial infarction
  • outcomes
  • trends

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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