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Improved outcomes in patients with ST-elevation myocardial infarction during the last 20 years are related to implementation of evidence-based treatments : experiences from the SWEDEHEART registry 1995-2014

Szummer, Karolina ; Wallentin, Lars ; Lindhagen, Lars ; Alfredsson, Joakim ; Erlinge, David LU orcid ; Held, Claes ; James, Stefan ; Kellerth, Thomas ; Lindahl, Bertil and Ravn-Fischer, Annica , et al. (2017) In European Heart Journal 38(41). p.3056-3065
Abstract

Aims: Impact of changes of treatments on outcomes in ST-elevation myocardial infarction (STEMI) patients in real-life health care has not been documented.

Methods and results: All STEMI cases (n = 105.674) registered in the nation-wide SWEDEHEART registry between 1995 and 2014 were included and followed for fatal and non-fatal outcomes for up to 20 years. Most changes in treatment and outcomes occurred from 1994 to 2008. Evidence-based treatments increased: reperfusion from 66.2 to 81.7%; primary percutaneous coronary intervention: 4.5 to 78.0%; dual antiplatelet therapy from 0 to 89.6%; statin: 14.1 to 93.6%; beta-blocker: 78.2 to 91.0%, and angiotensin-converting-enzyme/angiotensin-2-receptor inhibitors: 40.8 to 85.2% (P-value... (More)

Aims: Impact of changes of treatments on outcomes in ST-elevation myocardial infarction (STEMI) patients in real-life health care has not been documented.

Methods and results: All STEMI cases (n = 105.674) registered in the nation-wide SWEDEHEART registry between 1995 and 2014 were included and followed for fatal and non-fatal outcomes for up to 20 years. Most changes in treatment and outcomes occurred from 1994 to 2008. Evidence-based treatments increased: reperfusion from 66.2 to 81.7%; primary percutaneous coronary intervention: 4.5 to 78.0%; dual antiplatelet therapy from 0 to 89.6%; statin: 14.1 to 93.6%; beta-blocker: 78.2 to 91.0%, and angiotensin-converting-enzyme/angiotensin-2-receptor inhibitors: 40.8 to 85.2% (P-value for-trend <0.001 for all). One-year mortality decreased from 22.1 to 14.1%. Standardized incidence ratio compared with the general population decreased from 5.54 to 3.74 (P < 0.001). Cardiovascular (CV) death decreased from 20.1 to 11.1%, myocardial infarction (MI) from 11.5 to 5.8%; stroke from 2.9 to 2.1%; heart failure from 7.1 to 6.2%. After standardization for differences in demography and baseline characteristics, the change of 1-year CV-death or MI corresponded to a linear trend of 0.915 (95% confidence interval: 0.906-0.923) per 2-year period which no longer was significant, 0.997 (0.984-1.009), after adjustment for changes in treatment. The changes in treatment and outcomes were most pronounced from 1994 to 2008.

Conclusion: Gradual implementation of new and established evidence-based treatments in STEMI patients during the last 20 years has been associated with prolonged survival and lower risk of recurrent ischaemic events, although a plateauing is seen since around 2008.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
Journal Article
in
European Heart Journal
volume
38
issue
41
pages
3056 - 3065
publisher
Oxford University Press
external identifiers
  • pmid:29020314
  • wos:000414366100006
  • scopus:85035034233
ISSN
1522-9645
DOI
10.1093/eurheartj/ehx515
language
English
LU publication?
yes
id
785927d3-a733-4d3b-a284-a36e63afd29e
date added to LUP
2017-10-26 10:01:44
date last changed
2025-01-06 22:59:06
@article{785927d3-a733-4d3b-a284-a36e63afd29e,
  abstract     = {{<p>Aims: Impact of changes of treatments on outcomes in ST-elevation myocardial infarction (STEMI) patients in real-life health care has not been documented.</p><p>Methods and results: All STEMI cases (n = 105.674) registered in the nation-wide SWEDEHEART registry between 1995 and 2014 were included and followed for fatal and non-fatal outcomes for up to 20 years. Most changes in treatment and outcomes occurred from 1994 to 2008. Evidence-based treatments increased: reperfusion from 66.2 to 81.7%; primary percutaneous coronary intervention: 4.5 to 78.0%; dual antiplatelet therapy from 0 to 89.6%; statin: 14.1 to 93.6%; beta-blocker: 78.2 to 91.0%, and angiotensin-converting-enzyme/angiotensin-2-receptor inhibitors: 40.8 to 85.2% (P-value for-trend &lt;0.001 for all). One-year mortality decreased from 22.1 to 14.1%. Standardized incidence ratio compared with the general population decreased from 5.54 to 3.74 (P &lt; 0.001). Cardiovascular (CV) death decreased from 20.1 to 11.1%, myocardial infarction (MI) from 11.5 to 5.8%; stroke from 2.9 to 2.1%; heart failure from 7.1 to 6.2%. After standardization for differences in demography and baseline characteristics, the change of 1-year CV-death or MI corresponded to a linear trend of 0.915 (95% confidence interval: 0.906-0.923) per 2-year period which no longer was significant, 0.997 (0.984-1.009), after adjustment for changes in treatment. The changes in treatment and outcomes were most pronounced from 1994 to 2008.</p><p>Conclusion: Gradual implementation of new and established evidence-based treatments in STEMI patients during the last 20 years has been associated with prolonged survival and lower risk of recurrent ischaemic events, although a plateauing is seen since around 2008.</p>}},
  author       = {{Szummer, Karolina and Wallentin, Lars and Lindhagen, Lars and Alfredsson, Joakim and Erlinge, David and Held, Claes and James, Stefan and Kellerth, Thomas and Lindahl, Bertil and Ravn-Fischer, Annica and Rydberg, Erik and Yndigegn, Troels and Jernberg, Tomas}},
  issn         = {{1522-9645}},
  keywords     = {{Journal Article}},
  language     = {{eng}},
  month        = {{08}},
  number       = {{41}},
  pages        = {{3056--3065}},
  publisher    = {{Oxford University Press}},
  series       = {{European Heart Journal}},
  title        = {{Improved outcomes in patients with ST-elevation myocardial infarction during the last 20 years are related to implementation of evidence-based treatments : experiences from the SWEDEHEART registry 1995-2014}},
  url          = {{http://dx.doi.org/10.1093/eurheartj/ehx515}},
  doi          = {{10.1093/eurheartj/ehx515}},
  volume       = {{38}},
  year         = {{2017}},
}