Karolina Szummer1,2, Lars Wallentin3, Lars Lindhagen3, Joakim Alfredsson4,5, David Erlinge6, Claes Held3, Stefan James3, Thomas Kellerth7, Bertil Lindahl3, Annica Ravn-Fischer8, Erik Rydberg6, Troels Yndigegn6, Tomas Jernberg9. 1. Section of Cardiology, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden. 2. Department of Cardiology, Karolinska University Hospital Hälsovägen 4, Stockholm, Sweden. 3. Uppsala Clinical Research Center and Department of Medical Sciences, Uppsala University, Dag Hammarskjölds Väg 38, Uppsala, Sweden. 4. Department of Cardiology, Linköping University, Linköping, Sweden. 5. Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden. 6. Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Akutgatan 4, Lund, Sweden. 7. Department of Cardiology, Örebro University Hospital, Södra Grev Rosengatan, Örebro, Sweden. 8. Department of Molecular and Clinical Medicine, Institution of Medicine, Sahlgrenska University Hospital, Blå Stråket, Göteborg, Sweden. 9. Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Mörbygårdsvägen 88, Danderyd, Sweden.
Abstract
Aims: We assessed the changes in short- and long-term outcomes and their relation to implementation of new evidence-based treatments in all patients with non-ST-elevation myocardial infarction (NSTEMI) in Sweden over 20 years. Methods and results: Cases with NSTEMI (n = 205 693) between 1995 and 2014 were included from the nationwide Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) registry. During 20 years in-hospital invasive procedures increased from 1.9% to 73.2%, percutaneous coronary intervention or coronary artery bypass grafting 6.5% to 58.1%, dual antiplatelet medication 0% to 72.7%, statins 13.3% to 85.6%, and angiotensin-converting enzyme inhibitors/angiotensin II receptor blocker 36.8% to 75.5%. The standardized 1-year mortality ratio compared with a control population decreased from 5.53 [95% confidence interval (CI) 5.30-5.75] to 3.03 (95% CI 2.89-3.19). If patients admitted the first 2 years were modelled to receive the same invasive treatments as the last 2 years the expected mortality/myocardial infarction (MI) rate would be reduced from 33.0% to 25.0%. After adjusting for differences in baseline characteristics, the change of 1-year cardiovascular death/MI corresponded to a linearly decreasing odds ratio trend of 0.930 (95% CI 0.926-0.935) per 2-year period. This trend was substantially attenuated [0.970 (95% CI 0.964-0.975)] after adjusting for changes in coronary interventions, and almost eliminated [0.988 (95% CI 0.982-0.994)] after also adjusting for changes in discharge medications. Conclusion: In NSTEMI patients during the last 20 years, there has been a substantial improvement in long-term survival and reduction in the risk of new cardiovascular events. These improvements seem mainly explained by the gradual uptake and widespread use of in-hospital coronary interventions and evidence-based long-term medications.
Aims: We assessed the changes in short- and long-term outcomes and their relation to implementation of new evidence-based treatments in all patients with non-ST-elevation myocardial infarction (NSTEMI) in Sweden over 20 years. Methods and results: Cases with NSTEMI (n = 205 693) between 1995 and 2014 were included from the nationwide Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) registry. During 20 years in-hospital invasive procedures increased from 1.9% to 73.2%, percutaneous coronary intervention or coronary artery bypass grafting 6.5% to 58.1%, dual antiplatelet medication 0% to 72.7%, statins 13.3% to 85.6%, and angiotensin-converting enzyme inhibitors/angiotensin II receptor blocker 36.8% to 75.5%. The standardized 1-year mortality ratio compared with a control population decreased from 5.53 [95% confidence interval (CI) 5.30-5.75] to 3.03 (95% CI 2.89-3.19). If patients admitted the first 2 years were modelled to receive the same invasive treatments as the last 2 years the expected mortality/myocardial infarction (MI) rate would be reduced from 33.0% to 25.0%. After adjusting for differences in baseline characteristics, the change of 1-year cardiovascular death/MI corresponded to a linearly decreasing odds ratio trend of 0.930 (95% CI 0.926-0.935) per 2-year period. This trend was substantially attenuated [0.970 (95% CI 0.964-0.975)] after adjusting for changes in coronary interventions, and almost eliminated [0.988 (95% CI 0.982-0.994)] after also adjusting for changes in discharge medications. Conclusion: In NSTEMI patients during the last 20 years, there has been a substantial improvement in long-term survival and reduction in the risk of new cardiovascular events. These improvements seem mainly explained by the gradual uptake and widespread use of in-hospital coronary interventions and evidence-based long-term medications.
Authors: Daniel I Bromage; Tom R Godec; Mar Pujades-Rodriguez; Arturo Gonzalez-Izquierdo; S Denaxas; Harry Hemingway; Derek M Yellon Journal: Cardiovasc Diabetol Date: 2019-12-09 Impact factor: 8.949
Authors: Dorien M Kimenai; Bertil Lindahl; Tomas Jernberg; Otto Bekers; Steven J R Meex; Kai M Eggers Journal: Sci Rep Date: 2020-09-17 Impact factor: 4.379
Authors: Oliver J Liakopoulos; G Schlachtenberger; Daniel Wendt; Yeong-Hoon Choi; Ingo Slottosch; Henryk Welp; Wolfgang Schiller; Sven Martens; Armin Welz; Markus Neuhäuser; Heinz Jakob; Thorsten Wahlers; Matthias Thielmann Journal: J Am Heart Assoc Date: 2019-05-21 Impact factor: 5.501
Authors: Ingo Ahrens; Oleg Averkov; Eduardo C Zúñiga; Alan Y Y Fong; Khalid F Alhabib; Sigrun Halvorsen; Muhamad A B S K Abdul Kader; Ricardo Sanz-Ruiz; Robert Welsh; Hongbin Yan; Philip Aylward Journal: Clin Cardiol Date: 2019-07-17 Impact factor: 2.882
Authors: John Hung; Andreas Roos; Erik Kadesjö; David A McAllister; Dorien M Kimenai; Anoop S V Shah; Atul Anand; Fiona E Strachan; Keith A A Fox; Nicholas L Mills; Andrew R Chapman; Martin J Holzmann Journal: Eur Heart J Date: 2021-07-08 Impact factor: 35.855