Abstract 2859: Major Improvement in In-Hospital Mortality after STEMI from 2000 to 2005 in Relation to Improved Early Management: Results from the French USIC 2000 and FAST-MI Registries
Background: The use of reperfusion therapy and recommended medications has increased in recent years; the relation of better implementaion of recommendations with outcomes deserves clarification.
Aim: to compare in-hospital mortality in 2 nationwide registries 5 years apart.
Methods: USIC 2000 and FAST-MI are 2 nationwide French registries conducted 5 years apart, using a similar methodology in patients admitted to CCU over a one-month period. All 3,633 STEMI patients presenting ≤48 hrs of symptom onset were included.
Results: 1,922 patients were included in 2000 and 1,711 in 2005. Baseline characteristics were similar in most respects (age: 65±15 years; women 27 vs 30%; diabetes: 21% v 20%; smoking: 35% v 36%; anterior location: 39% v 38%). Reperfusion therapy increased from 50% to 60% (p<0.001), with a shift from in-hospital thrombolysis (19% to 10%) to prehospital lysis (9% to 18%) and primary PCI (23% to 33%). Medications used during the first 48 hours increased significantly for GP IIb/IIIa inhibitors (18% to 36%), LMWH (28% to 57%), ACE-inhibitors (41% to 48%) and statins (45% to 77%) but were unchanged for antiplatelet agents (95% v 96%) and beta-blockers (71% v 71%). Mortality decreased markedly from 9.3% to 6.7% (-28%, p=0.003). We used 3 models of x-variate regression analysis to determine independent predictors of in-hospital mortality. In model 1, including all baseline parameters, modes of reperfusion therapy and chronic pre-admission medications, study period was associated with lower mortality (OR: 0.65; 95%CI: 0.50–0.84). However, in model 2, additionally including medications used during the first 48 hours, use of LMWH (OR: 0.52), beta-blockers (OR: 0.48), statins (OR: 0.43) and ACE-I (OR: 0.71) were all significantly associated with hospital mortality and the study period was no longer significant. In model 3, were patients dying ≤ 48 hrs were excluded to avoid bias, early beta-blockers (OR: 0.50), statins (OR: 0.55) and LMWH (OR: 0.69) remained significant predictors of mortality.
Conclusion: Use of recommended therapeutic strategies, such as statins or LMWH, at the acute stage of STEMI, together with increased use of reperfusion therapy, is associated with the rapid decrease in hospital mortality observed in the past 5 years.