Mortality rates decline for patients with non-STEMI, remain stable in STEMI
Risk factors for patients with acute MI have changed modestly as treatment has improved, with mortality rates significantly declining for patients with non-STEMI and remaining stable for patients with STEMI.
The research, published in Circulation: Cardiovascular Quality and Outcomes, examined the changes in treatment, characteristics, management and clinical and CV outcomes of acute MI over 10 years due to limited data on how these changes affect patients.
“Despite increase in comorbidities like diabetes and atrial fibrillation, both unadjusted and risk adjusted mortality has decreased significantly in non-STEMI patients over the last 10 years,” Sanjay Gandhi, MBBS, MBA, president of the medical staff at The MetroHealth System in Cleveland, told Healio. “This is likely due to increased adherence to guideline-directed therapy and increased use of early catheterization and revascularization in these patients.”
To assess the trends in STEMI and non-STEMI patient treatment, characteristics and outcomes, the researchers used the Chest Pain-MI (CPMI) registry to analyze records of 604,936 patients with STEMI and 933,755 patients with non-STEMI from 2009 to 2018 across 1,230 hospitals in the U.S. The researchers also calculated risk-adjusted mortality rates, including cardiac arrest at hospital presentation, from 2011 to 2018.
Among both patients with STEMI and non-STEMI, the prevalence of diabetes and atrial fibrillation increased, despite the decrease in mortality rates. In patients with STEMI, diabetes rose from 22.8% in 2009 to 28.3% in 2018 and AF rose from 4.1% in 2009 to 6.1% in 2018, whereas in patients with non-STEMI, diabetes rose from 35.7% in 2009 to 41.3% in 2018 and AF rose from 9.4% in 2009 to 11.7% in 2018 (P for all < .001).
Notably, the risk-adjusted mortality rate was stable in STEMI patients (2009, 2.8%; 2018, 2.7%; P = .46) and decreased in non-STEMI patients (2009, 1.9%; 2018, 1.3%; P = .0001), according to the study.
“We were intrigued that despite these improvements in care measures, the risk-adjusted mortality rate did not change significantly in STEMI patients,” Gandhi told Healio. “We believe this may be related to increased comorbidities like diabetes and atrial fibrillation that are not included in the ACTION risk-adjusted mortality model.”
Researchers also noted a decrease in smoking among both those with STEMI and those with non-STEMI (43.5% to 37.9% and 30.2% to 27.5% respectively; P for all <.001). Researchers also found that primary PCI use also increased from 82.3% to 96% for patients with STEMI and from 43.9% to 54.5% for patients with non-STEMI.
Reperfusion times also significantly decreased in patients with STEMI who had PCI, the authors noted. The median door-to-device time dropped from 62 minutes in 2009 to 56 minutes in 2018, and the median first medical contact-to-device time from 90 minutes in 2009 to 82 minutes in 2018 (P for all < .001), the researchers wrote.
“This report provides temporal trends in patient characteristics, and care of patients with STEMI and non-STEMI in United States and confirms that there has been a steady improvement in process measures and high adherence to guideline-directed medical therapy in this patient population,” the researchers wrote. “The in-hospital risk-adjusted mortality rate has remained stable for patients with STEMI and improved for patients with non-STEMI. The CPMI registry continues to play an important role in performance improvement efforts across the country.”
For more information:
Sanjay Gandhi, MBBS, MBA, can be reached at email@example.com.