open access

Vol 26, No 5 (2019)
Original articles — Interventional cardiology
Published online: 2018-06-05
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Survival benefit from recent changes in management of men and women with ST-segment elevation myocardial infarction treated with percutaneous coronary interventions

Łukasz Zandecki, Marcin Sadowski, Marianna Janion, Jacek Kurzawski, Marek Gierlotka, Lech Poloński, Mariusz Gąsior
DOI: 10.5603/CJ.a2018.0057
·
Pubmed: 29924379
·
Cardiol J 2019;26(5):459-468.

open access

Vol 26, No 5 (2019)
Original articles — Interventional cardiology
Published online: 2018-06-05

Abstract

Background: Nowadays, the majority of patients with myocardial infarction with ST-segment elevation (STEMI) are treated with primary percutaneous coronary interventions (PCI). In recent years, there have been ongoing improvements in PCI techniques, devices and concomitant pharmacotherapy. However, reports on further mortality reduction among PCI-treated STEMI patients remain inconclusive. The aim of this study was to compare changes in management and mortality in PCI-treated STEMI patients between 2005 and 2011 in a real-life setting. Methods: Data on 79,522 PCI-treated patients with STEMI from Polish Registry of Acute Coronary Syndromes (PL-ACS) admitted to Polish hospitals between 2005 and 2011 were analyzed. First, temporal trends of in-hospital management in men and women were presented. In the next step, patients from 2005 and 2011 were nearest neighbor matched on their propensity scores to compare in-hospital, 30-day and 1-year mortality rates and in-hospital management strategies and complications. Results: Some significant changes were noted in hospital management including shortening of median times from admission to PCI, increased use of drug-eluting stents, potent antiplatelet agents but also less frequent use of statin, beta-blockers and angiotensin converting enzyme inhibitors and angiotensin II receptor blockers. There was a strong tendency toward preforming additional PCI of non-infarct related arteries, especially in women. After propensity score adjustment there were significant changes in inhospital but not in 30-day or 1-year mortality rates between 2005 and 2011. The results were similar in men and women. Conclusions: There were apparent changes in management and significant in-hospital mortality reductions in PCI-treated STEMI patients between 2005 and 2011. However, it did not result in 30-day or 1-year survival benefit at a population level. There may be room for improvement in the use of guideline-recommended pharmacotherapy.

Abstract

Background: Nowadays, the majority of patients with myocardial infarction with ST-segment elevation (STEMI) are treated with primary percutaneous coronary interventions (PCI). In recent years, there have been ongoing improvements in PCI techniques, devices and concomitant pharmacotherapy. However, reports on further mortality reduction among PCI-treated STEMI patients remain inconclusive. The aim of this study was to compare changes in management and mortality in PCI-treated STEMI patients between 2005 and 2011 in a real-life setting. Methods: Data on 79,522 PCI-treated patients with STEMI from Polish Registry of Acute Coronary Syndromes (PL-ACS) admitted to Polish hospitals between 2005 and 2011 were analyzed. First, temporal trends of in-hospital management in men and women were presented. In the next step, patients from 2005 and 2011 were nearest neighbor matched on their propensity scores to compare in-hospital, 30-day and 1-year mortality rates and in-hospital management strategies and complications. Results: Some significant changes were noted in hospital management including shortening of median times from admission to PCI, increased use of drug-eluting stents, potent antiplatelet agents but also less frequent use of statin, beta-blockers and angiotensin converting enzyme inhibitors and angiotensin II receptor blockers. There was a strong tendency toward preforming additional PCI of non-infarct related arteries, especially in women. After propensity score adjustment there were significant changes in inhospital but not in 30-day or 1-year mortality rates between 2005 and 2011. The results were similar in men and women. Conclusions: There were apparent changes in management and significant in-hospital mortality reductions in PCI-treated STEMI patients between 2005 and 2011. However, it did not result in 30-day or 1-year survival benefit at a population level. There may be room for improvement in the use of guideline-recommended pharmacotherapy.

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Keywords

ST-segment elevation myocardial infarction; percutaneous coronary intervention; temporal trends; treatment strategy; in-hospital mortality; 1-year mortality; sex-differences

About this article
Title

Survival benefit from recent changes in management of men and women with ST-segment elevation myocardial infarction treated with percutaneous coronary interventions

Journal

Cardiology Journal

Issue

Vol 26, No 5 (2019)

Pages

459-468

Published online

2018-06-05

DOI

10.5603/CJ.a2018.0057

Pubmed

29924379

Bibliographic record

Cardiol J 2019;26(5):459-468.

Keywords

ST-segment elevation myocardial infarction
percutaneous coronary intervention
temporal trends
treatment strategy
in-hospital mortality
1-year mortality
sex-differences

Authors

Łukasz Zandecki
Marcin Sadowski
Marianna Janion
Jacek Kurzawski
Marek Gierlotka
Lech Poloński
Mariusz Gąsior

References (34)
  1. Radovanovic D, Nallamothu BK, Seifert B, et al. Temporal trends in treatment of ST-elevation myocardial infarction among men and women in Switzerland between 1997 and 2011. Eur Heart J Acute Cardiovasc Care. 2012; 1(3): 183–191.
  2. Poloński L, Gąsior M, Gierlotka M, et al. What has changed in the treatment of ST-segment elevation myocardial infarction in Poland in 2003-2009? Data from the Polish Registry of Acute Coronary Syndromes (PL-ACS). Kardiol Pol. 2011; 69(11): 1109–1118.
  3. Peterson ED, Shah BR, Parsons L, et al. Trends in quality of care for patients with acute myocardial infarction in the National Registry of Myocardial Infarction from 1990 to 2006. Am Heart J. 2008; 156(6): 1045–1055.
  4. Hong MK. Recent Advances in the Treatment of ST-Segment Elevation Myocardial Infarction. Scientifica (Cairo). 2012; 2012: 683683.
  5. Corrada E, Ferrante G, Mazzali C, et al. Eleven-year trends in gender differences of treatments and mortality in ST-elevation acute myocardial infarction in northern Italy, 2000 to 2010. Am J Cardiol. 2014; 114(3): 336–341.
  6. Jackson EA, Moscucci M, Smith DE, et al. The association of sex with outcomes among patients undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction in the contemporary era: Insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2). Am Heart J. 2011; 161(1): 106–112.e1.
  7. Freisinger E, Fuerstenberg T, Malyar NM, et al. German nationwide data on current trends and management of acute myocardial infarction: discrepancies between trials and real-life. Eur Heart J. 2014; 35(15): 979–988.
  8. Tousek P, Tousek F, Horak D, et al. The incidence and outcomes of acute coronary syndromes in a central European country: results of the CZECH-2 registry. Int J Cardiol. 2014; 173(2): 204–208.
  9. Velders MA, James SK, Libungan B, et al. Prognosis of elderly patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention in 2001 to 2011: A report from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) registry. Am Heart J. 2014; 167(5): 666–673.
  10. Puymirat E, Simon T, Steg PG, et al. Association of changes in clinical characteristics and management with improvement in survival among patients with ST-elevation myocardial infarction. JAMA. 2012; 308(10): 998–1006.
  11. Gale CP, Allan V, Cattle BA, et al. Trends in hospital treatments, including revascularisation, following acute myocardial infarction, 2003-2010: a multilevel and relative survival analysis for the National Institute for Cardiovascular Outcomes Research (NICOR). Heart. 2014; 100(7): 582–589.
  12. Zandecki L, Sadowski M, Janion M, et al. Trends in sex differences in clinical characteristics, treatment strategies, and mortality in patients with ST-elevation myocardial infarction in Poland from 2005 to 2011. Coron Artery Dis. 2017; 28(5): 417–425.
  13. Novak K, Vrdoljak D, Jelaska I, et al. Sex-specific differences in risk factors for in-hospital mortality and complications in patients with acute coronary syndromes : An observational cohort study. Wien Klin Wochenschr. 2017; 129(7-8): 233–242.
  14. Sadowski M, Gasior M, Gierlotka M, et al. Gender-related differences in mortality after ST-segment elevation myocardial infarction: a large multicentre national registry. EuroIntervention. 2011; 6(9): 1068–1072.
  15. Kołodziej M, Kurzawski J, Janion-Sadowska A, et al. Mortality of women with ST-segment elevation myocardial infarction and cardiogenic shock – results from the PL-ACS registry. Medical Studies. 2016; 3: 157–163.
  16. De Luca L, Marini M, Gonzini L, et al. Contemporary Trends and Age-Specific Sex Differences in Management and Outcome for Patients With ST-Segment Elevation Myocardial Infarction. J Am Heart Assoc. 2016; 5(12).
  17. Kunadian V, Qiu W, Lagerqvist Bo, et al. Gender Differences in Outcomes and Predictors of All-Cause Mortality After Percutaneous Coronary Intervention (Data from United Kingdom and Sweden). Am J Cardiol. 2017; 119(2): 210–216.
  18. Pedersen F, Butrymovich V, Kelbæk H, et al. Short- and long-term cause of death in patients treated with primary PCI for STEMI. J Am Coll Cardiol. 2014; 64(20): 2101–2108.
  19. Kaul P, Armstrong PW, Sookram S, et al. Temporal trends in patient and treatment delay among men and women presenting with ST-elevation myocardial infarction. Am Heart J. 2011; 161(1): 91–97.
  20. Nallamothu BK, Normand SLT, Wang Y, et al. Relation between door-to-balloon times and mortality after primary percutaneous coronary intervention over time: a retrospective study. Lancet. 2015; 385(9973): 1114–1122.
  21. Dreyer RP, Beltrame JF, Tavella R, et al. Evaluation of gender differences in Door-to-Balloon time in ST-elevation myocardial infarction. Heart Lung Circ. 2013; 22(10): 861–869.
  22. Hiteshi AK, Li D, Gao Y, et al. Gender differences in coronary artery diameter are not related to body habitus or left ventricular mass. Clin Cardiol. 2014; 37(10): 605–609.
  23. Kastrati A, Dibra A, Spaulding C, et al. Meta-analysis of randomized trials on drug-eluting stents vs. bare-metal stents in patients with acute myocardial infarction. Eur Heart J. 2007; 28(22): 2706–2713.
  24. Steg PhG, James SK, Atar D, et al. Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012; 33(20): 2569–2619.
  25. Thiele H, Akin I, Sandri M, et al. PCI strategies in patients with acute myocardial infarction and cardiogenic shock. N Engl J Med. 2017; 377(25): 2419–2432.
  26. Levine G, Bates E, Blankenship J, et al. 2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction. J Am Coll Cardiol. 2016; 67(10): 1235–1250.
  27. Wald DS, Morris JK, Wald NJ, et al. Randomized trial of preventive angioplasty in myocardial infarction. N Engl J Med. 2013; 369(12): 1115–1123.
  28. Gershlick AH, Khan JN, Kelly DJ, et al. Randomized trial of complete versus lesion-only revascularization in patients undergoing primary percutaneous coronary intervention for STEMI and multivessel disease: the CvLPRIT trial. J Am Coll Cardiol. 2015; 65(10): 963–972.
  29. Engstrøm T, Kelbæk H, Helqvist S, et al. Complete revascularisation versus treatment of the culprit lesion only in patients with ST-segment elevation myocardial infarction and multivessel disease (DANAMI-3—PRIMULTI): an open-label, randomised controlled trial. Lancet. 2015; 386(9994): 665–671.
  30. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018; 39(2): 119–177.
  31. ISIS-4: a randomised factorial trial assessing early oral captopril, oral mononitrate, and intravenous magnesium sulphate in 58,050 patients with suspected acute myocardial infarction. ISIS-4 (Fourth International Study of Infarct Survival) Collaborative Group. Lancet. 1995; 345(8951): 669–685.
  32. Angeli F, Reboldi G, Mazzotta G, et al. Statins in acute coronary syndrome: very early initiation and benefits. Ther Adv Cardiovasc Dis. 2012; 6(4): 163–174.
  33. Chen ZM, Pan HC, Chen YP, et al. Early intravenous then oral metoprolol in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet. 2005; 366(9497): 1622–1632.
  34. García-García C, Ribas N, Recasens LL, et al. In-hospital prognosis and long-term mortality of STEMI in a reperfusion network. "Head to head" analisys: invasive reperfusion vs optimal medical therapy. BMC Cardiovasc Disord. 2017; 17(1): 139.

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