A national registry in Sweden captures comprehensive data on the evolution of STEMI treatment and outcomes.

Several reports have described trends in therapy and outcomes in patients with myocardial infarction (MI), but few have included unrestricted populations. This study focuses on trends in evidence-based therapies and mortality in 61,238 patients who had a first-time diagnosis of ST-segment-elevation MI (STEMI) at acute cardiac care hospitals throughout Sweden from 1996 through 2007.

Over the study period, the mean age of the STEMI patients decreased from 71 to 69; rates of baseline hypertension and cigarette use increased; and the proportions taking statins, angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs), or both at admission increased. The rate of fibrinolysis declined from 66% in 1996–1997 to 7% in 2006–2007, with concomitant increases in the rates of angiography (from 12% to 93%) and primary percutaneous coronary intervention (from 12% to 61%). Rates of guideline-recommended medication use, including aspirin, clopidogrel, beta-blockers, ACE inhibitors or ARBs, and statins, increased significantly over time, and hospital-to-hospital variability in the use of all of these medications except ACE inhibitors or ARBs narrowed. Mortality at 1 year, standardized for differences in baseline patient characteristics, decreased substantially, from 19.0% in 1996 to 11.2% in 2007.

Comment: This study in an unselected Swedish population revealed a marked decline in mortality concurrent with the adoption of evidence-based therapies for STEMI. Although the observational analysis cannot rule out unmeasured factors that might have played a role in producing these gratifying improvements in outcome, better treatment must have been an important contributor. The fact that 8 in 100 patients treated in 1996 who died may have been alive at 1 year had they been treated in 2007 strongly supports systematic efforts to continually improve delivery of the right therapies to the right STEMI patients at the right time.

Source: Journal Watch Cardiology