Etienne Puymirat1, Guillaume Cayla2, Yves Cottin3, Meyer Elbaz4, Patrick Henry5, Edouard Gerbaud6, Gilles Lemesle7, Batric Popovic8, Jean-Noel Labèque9, François Roubille10, Stéphane Andrieu11, Bruno Farah12, François Schiele13, Jean Ferrières14, Tabassome Simon15, Nicolas Danchin16. 1. Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, 75015 Paris; Université Paris-Descartes, 75006 Paris, France. Electronic address: etienne.puymirat@aphp.fr. 2. Centre Hospitalier Universitaire de Nîmes, 30900 Nîmes, France. 3. Centre Hospitalier Universitaire du Bocage, 21000, Dijon, France. 4. Toulouse University Hospital, Department of Cardiology, 31059 Toulouse, France. 5. Hôpital Lariboisière, Department of Cardiology, 75010, Paris, France. 6. Hôpital Cardiologique Haut Levêque, CHU de Bordeaux, 33600, Pessac, France. 7. Lille Regional University Hospital, Department of Cardiology, 59037 Lille, France. 8. Département de cardiologie, CHU de Nancy, 54511, Vandœuvre-lès-Nancy, France. 9. Centre Hospitalier de la Côte Basque, 64100, Bayonne, France. 10. Montpellier University Hospital, Department of Cardiology, 34090 Montpellier, France. 11. Centre Hospitalier Henri Duffaut, Department of Cardiology, 84902, Avignon, France. 12. Clinique Pasteur, Department of Cardiology, 31059, Toulouse, France. 13. University Hospital Jean Minjoz, Department of Cardiology, 25030 Besançon, France. 14. Toulouse Rangueil University Hospital, Department of Cardiology; UMR1027, INSERM, 31059 Toulouse, France. 15. AP-HP, Hôpital Saint Antoine, Department of Clinical Pharmacology and Clinical Research Platform of east of Paris (URCEST-CRBH-UEP-CRC-EST), 75012 Paris, France ; Sorbonne-Université (UPMC-Paris 06) ; INSERM U-698, 75012, Paris, France. 16. Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, 75015 Paris; Université Paris-Descartes, 75006 Paris, France.
Abstract
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). METHODS: 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. RESULTS: 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 < .001) and in those without reperfusion therapy (from 25.0% to 18.2% in 2010 and 8.1% in 2015, HR: 0.33; 95% CI: 0.24-0.47, P < .001). CONCLUSIONS: In STEMI patients, one-year mortality continues to decline, both related to increased use of reperfusion therapy and progress in overall patient management. In patients with reperfusion therapy, mortality has remained stable since 2010, while it has continued to decline in patients without reperfusion therapy.
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). METHODS: 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. RESULTS: 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 < .001) and in those without reperfusion therapy (from 25.0% to 18.2% in 2010 and 8.1% in 2015, HR: 0.33; 95% CI: 0.24-0.47, P < .001). CONCLUSIONS: In STEMI patients, one-year mortality continues to decline, both related to increased use of reperfusion therapy and progress in overall patient management. In patients with reperfusion therapy, mortality has remained stable since 2010, while it has continued to decline in patients without reperfusion therapy.
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