Primary PCI strategy reduces death rates in STEMI patients

Between 2003 and 2018, 1-year mortality has decreased considerably in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) in a high-income European country with a fully implemented primary PCI strategy, reports a study.

In addition, nearly three-quarters of the reduction in mortality has occurred within the first 30 days following the procedure.

In this study, the researchers identified first-time PCI-treated patients undergoing primary PCI for STEM from 2003 to 2018 using the Western Denmark Heart Registry. Using the Danish national health registries, they divided participants into four time-interval groups based on the year of primary PCI and followed them for 1 year.

Overall, 19,613 patients (median 64 years, 74 percent male) were included. Mortality at 1 year gradually decreased from 10.8 percent in 2003‒2006, 10.4 percent in 2007‒2010, and 9.1 percent in 2011‒2014 to 7.7 percent in 2015‒2018 (2015‒2018 vs 2003‒2006: adjusted hazard ratio [aHR], 0.71, 95 percent confidence interval [CI], 0.62‒0.82).

The highest decline in absolute mortality occurred in the 0- to 30-day period, with a decrease of 2.3 percent (aHR, 0.69, 95 percent CI, 0.59‒0.82) and, to a lesser extent, in the 31- to 365-day period (risk reduction: 1.0 percent; aHR, 0.71, 95 percent CI, 0.56‒0.90).

“These results indicate that optimization of early management of primary PCI-treated patients with STEMI offers great opportunities for improving overall survival in contemporary clinical practice,” the researchers said.