Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
J Am Coll Cardiol. 2023 Sep 5;82(10):999-1010. doi: 10.1016/j.jacc.2023.06.025.
Observational studies have reported that mortality rates after ST-segment elevation myocardial infarction (STEMI) have been stable since 2006 to 2010.
The aim of this study was to evaluate the temporal trends in 1-year, 30-day, and 31- to 365-day mortality after STEMI in Western Denmark where primary percutaneous coronary intervention (PCI) has been the national reperfusion strategy since 2003.
Using the Western Denmark Heart Registry, the study identified first-time PCI-treated patients undergoing primary PCI (pPCI) for STEMI from 2003 to 2018. Based on the year of pPCI, patients were divided into 4 time-interval groups and followed up for 1 year using the Danish national health registries.
A total of 19,613 patients were included. Median age was 64 years, and 74% were male. One-year mortality decreased gradually from 10.8% in 2003-2006, 10.4% in 2007-2010, 9.1% in 2011-2014, to 7.7% in 2015-2018 (2015-2018 vs 2003-2006: adjusted HR [aHR]: 0.71; 95% CI: 0.62-0.82). The largest absolute mortality decline occurred in the 0- to 30-day period with a 2.3% reduction (aHR: 0.69; 95% CI: 0.59-0.82), and to a lesser extent in the 31- to 365-day period (risk reduction: 1.0%; aHR: 0.71; 95% CI: 0.56-0.90).
In a high-income European country with a fully implemented pPCI strategy, 1-year mortality in pPCI-treated patients with STEMI decreased substantially between 2003 and 2018. Approximately three-quarters of the absolute mortality reduction occurred within the first 30 days after pPCI. These results indicate that optimization of early management of pPCI-treated patients with STEMI offers great opportunities for improving overall survival in contemporary clinical practice.
观察性研究报告称，自 2006 年至 2010 年，ST 段抬高型心肌梗死（STEMI）患者的死亡率一直保持稳定。
本研究旨在评估在丹麦西部，经皮冠状动脉介入治疗（pPCI）自 2003 年以来一直是国家再灌注策略的情况下，STEMI 患者 pPCI 后 1 年、30 天和 31-365 天死亡率的时间趋势。
使用丹麦西部心脏注册中心，本研究确定了 2003 年至 2018 年期间首次接受 pPCI 治疗的 STEMI 患者。根据 pPCI 年份，患者被分为 4 个时间间隔组，并通过丹麦国家健康登记系统随访 1 年。
共纳入 19613 例患者。中位年龄为 64 岁，74%为男性。1 年死亡率逐渐下降，从 2003-2006 年的 10.8%、2007-2010 年的 10.4%、2011-2014 年的 9.1%，降至 2015-2018 年的 7.7%（2015-2018 年 vs 2003-2006 年：调整后的 HR[aHR]：0.71；95%CI：0.62-0.82）。最大的绝对死亡率下降发生在 0-30 天内，降低了 2.3%（aHR：0.69；95%CI：0.59-0.82），而在 31-365 天内的降幅较小（风险降低：1.0%；aHR：0.71；95%CI：0.56-0.90）。
在一个高收入的欧洲国家，完全实施 pPCI 策略后，STEMI 接受 pPCI 治疗的患者的 1 年死亡率在 2003 年至 2018 年间大幅下降。绝对死亡率降低的约四分之三发生在 pPCI 后 30 天内。这些结果表明，优化 STEMI 接受 pPCI 治疗患者的早期管理为改善当代临床实践中的总体生存率提供了巨大机会。
