Etienne Puymirat1, François Schiele2, Philippe Gabriel Steg3, Didier Blanchard4, Marc-Antoine Isorni5, Johanne Silvain6, Patrick Goldstein7, Pascal Guéret8, Geneviève Mulak9, Laurence Berard10, Vincent Bataille11, Simon Cattan12, Jean Ferrières13, Tabassome Simon14, Nicolas Danchin5. 1. Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, 75015 Paris, France; Université Paris-Descartes, 75006 Paris, France; INSERM U-970, 75015 Paris, France. Electronic address: etiennepuymirat@yahoo.fr. 2. University Hospital Jean Minjoz, Department of Cardiology, 25030 Besançon, France. 3. AP-HP, Hôpital Bichat, Paris, France; Université Paris-Diderot, Sorbonne Paris-Cité, 75018 Paris, France; INSERM U-970, 75018 Paris, France. 4. Clinique St Gatien, 37000 Tours, France. 5. Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, 75015 Paris, France; Université Paris-Descartes, 75006 Paris, France. 6. Institut de Cardiologie, Centre Hospitalier Pitié-Salpêtrière, 75013 Paris, France. 7. Lille Regional University Hospital, Emergency Department, 59037 Lille, France. 8. University Hospital Henri Mondor, Department of Cardiology, 94010 Créteil, France. 9. Société Française de Cardiologie, 75012 Paris, France. 10. AP-HP, Hôpital Saint Antoine, Department of Clinical Pharmacology and Centre de Recherche Clinique (URCEST), 75012 Paris, France. 11. Toulouse University Hospital, Department of Cardiologie B and Epidemiology, Toulouse, France; INSERM U-558, 31059 Toulouse, France. 12. Intercity Hospital Le Raincy-Montfermeil, Department of Cardiology, 93370 Montfermeil, France. 13. Toulouse Rangueil University Hospital, Department of Cardiology, France; UMR1027, INSERM, 31059 Toulouse, France. 14. AP-HP, Hôpital Saint Antoine, Department of Clinical Pharmacology and Unité de Recherche Clinique (URCEST), 75012 Paris, France; Université Pierre et Marie Curie (UPMC-Paris 06), France; INSERM U-698, 75012 Paris, France.
Abstract
BACKGROUND: Improved early outcome in non-ST elevation myocardial infarction (NSTEMI) patients has been mainly attributed to a broader use of invasive strategies. Little is known about the impact of other changes in early management. METHODS: We aimed to assess 15-year trends in one-year mortality and their determinants in NSTEMI patients. We used data from 4 one-month French registries, conducted 5 years apart from 1995 to 2010 including 3903 NSTEMI patients admitted to intensive care units. RESULTS: From 1995 to 2010, no major change was observed in patient characteristics, while therapeutic management evolved considerably. Early use of antiplatelet agents, β-blockers, ACE-inhibitors and statins increased over time (P < 0.001); use of newer anticoagulants (low-molecular-weight heparin, bivalirudin or fondaparinux) increased from 40.8% in 2000 to 78.9% in 2010 (P < 0.001); percutaneous coronary intervention (PCI)≤ 3 days of admission rose from 7.6% to 48.1% (P < 0.001). One-year death decreased from 20% to 9.8% (HR adjusted for baseline parameters, 2010 vs. 1995 = 0.47, 95% CI: 0.35-0.62). Early PCI (HR = 0.67; 95% CI: 0.49-0.90), use of newer anticoagulants (HR = 0.62; 95% CI: 0.48-0.78) and early use of evidence based medical therapy (HR = 0.54; 95% CI: 0.40-0.72) were predictors of improved one year-survival. CONCLUSIONS: One-year mortality of NSTEMI patients decreased by 50% in the past 15years. Our data support current guidelines recommending early invasive strategies and use of newer anticoagulants for NSTEMI, and also show a strong positive association between early use of appropriate medical therapies and one-year survival, suggesting that these medications should be used from the start.
BACKGROUND: Improved early outcome in non-ST elevation myocardial infarction (NSTEMI) patients has been mainly attributed to a broader use of invasive strategies. Little is known about the impact of other changes in early management. METHODS: We aimed to assess 15-year trends in one-year mortality and their determinants in NSTEMI patients. We used data from 4 one-month French registries, conducted 5 years apart from 1995 to 2010 including 3903 NSTEMI patients admitted to intensive care units. RESULTS: From 1995 to 2010, no major change was observed in patient characteristics, while therapeutic management evolved considerably. Early use of antiplatelet agents, β-blockers, ACE-inhibitors and statins increased over time (P < 0.001); use of newer anticoagulants (low-molecular-weight heparin, bivalirudin or fondaparinux) increased from 40.8% in 2000 to 78.9% in 2010 (P < 0.001); percutaneous coronary intervention (PCI)≤ 3 days of admission rose from 7.6% to 48.1% (P < 0.001). One-year death decreased from 20% to 9.8% (HR adjusted for baseline parameters, 2010 vs. 1995 = 0.47, 95% CI: 0.35-0.62). Early PCI (HR = 0.67; 95% CI: 0.49-0.90), use of newer anticoagulants (HR = 0.62; 95% CI: 0.48-0.78) and early use of evidence based medical therapy (HR = 0.54; 95% CI: 0.40-0.72) were predictors of improved one year-survival. CONCLUSIONS: One-year mortality of NSTEMI patients decreased by 50% in the past 15years. Our data support current guidelines recommending early invasive strategies and use of newer anticoagulants for NSTEMI, and also show a strong positive association between early use of appropriate medical therapies and one-year survival, suggesting that these medications should be used from the start.
Authors: Jérémie Abtan; Deepak L Bhatt; Yedid Elbez; Emmanuel Sorbets; Kim Eagle; Yasuo Ikeda; David Wu; Mary E Hanson; Hakima Hannachi; Puneet K Singhal; Philippe Gabriel Steg; Gregory Ducrocq Journal: Clin Cardiol Date: 2016-09-02 Impact factor: 2.882
Authors: Jennifer Hulme; Hasan Sheikh; Edward Xie; Evgenia Gatov; Chenthila Nagamuthu; Paul Kurdyak Journal: CMAJ Date: 2020-11-23 Impact factor: 8.262
Authors: Dirk Westermann; Shaun G Goodman; José C Nicolau; Gema Requena; Andrew Maguire; Ji Yan Chen; Christopher B Granger; Richard Grieve; Stuart J Pocock; Stefan Blankenberg; Ana Maria Vega; Satoshi Yasuda; Tabassome Simon; David Brieger Journal: Clin Cardiol Date: 2017-12-16 Impact factor: 2.882
Authors: Franz Goss; Johannes Brachmann; Christian W Hamm; Winfried Haerer; Nicolaus Reifart; Benny Levenson Journal: Vasc Health Risk Manag Date: 2017-04-06
Authors: Padmaa Venkatason; Nur Lisa Zaharan; Muhammad Dzafir Ismail; Wan Azman Wan Ahmad; Ahmad Syadi Mahmood Zuhdi Journal: Eur J Clin Pharmacol Date: 2018-03-26 Impact factor: 2.953