Twenty-year trends in profile, management and outcomes of patients with ST-segment elevation myocardial infarction according to use of reperfusion therapy: Data from the FAST-MI program 1995-2015

• Published in: The American heart journal 2019-08, Vol.214, p.97-106
• Main Authors: Puymirat, Etienne, Cayla, Guillaume, Cottin, Yves, Elbaz, Meyer, Henry, Patrick, Gerbaud, Edouard, Lemesle, Gilles, Popovic, Batric, Labèque, Jean-Noel, Roubille, François, Andrieu, Stéphane, Farah, Bruno, Schiele, François, Ferrières, Jean, Simon, Tabassome, Danchin, Nicolas
• Format: Article
• Language: English
• Subjects: Anticoagulants; Biomedical research; Cardiology and cardiovascular system; Cardiovascular disease; Clinical medicine; Coronary vessels; Electrocardiography; Family medical history; Female; Fibrinolysis; Fibrinolytic Agents - therapeutic use; France; Heart attacks; Hospitals; Human health and pathology; Humans; Intensive care units; Life Sciences; Male; Management; Medical imaging; Middle Aged; Mortality; Mortality - trends; Myocardial infarction; Myocardial Reperfusion - mortality; Myocardial Reperfusion - trends; Patients; Percutaneous Coronary Intervention - mortality; Percutaneous Coronary Intervention - trends; Registries; Reperfusion; Santé publique et épidémiologie; Sex Factors; ST Elevation Myocardial Infarction - mortality; ST Elevation Myocardial Infarction - therapy; Therapy; Time Factors; Time-to-Treatment - statistics & numerical data; Time-to-Treatment - trends; Treatment Outcome; Trends; Variables
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2019.05.007

The increased use of reperfusion therapy in ST-segment-elevation myocardial infarction (STEMI) patients in the past decades is generally considered the main determinant of improved outcomes. The aim was to assess 20-year trends in profile, management, and one-year outcomes in STEMI patients in relation with use or non-use of reperfusion therapy (primary percutaneous coronary intervention (pPCI) or fibrinolysis). We used data from 5 one-month French nationwide registries, conducted 5 years apart from 2005 to 2015, including 8579 STEMI patients (67% with and 33% without reperfusion therapy) admitted to cardiac intensive care units in France. Use of reperfusion therapy increased from 49% in 1995 to 82% in 2015, with a shift from fibrinolysis (37.5% to 6%) to pPCI (12% to 76%). Early use of evidence-based medications gradually increased over the period in both patients with and without reperfusion therapy, although it remained lower at all times in those without reperfusion therapy. One-year mortality decreased in patients with reperfusion therapy (from 11.9% in 1995 to 5.9% in 2010 and 2015, hazard ratio [HR] adjusted on baseline profile 0.40; 95% CI: 0.29-0.54, P