Abstract 5605: Significant Reduction of Hospital Mortality of Stemi in Clinical Practice 1994–2008 Through Improvement of Guideline Adherence: Results of MITRAplus and OPTAMI
Background: Data from national and international myocardial infarction registries have identified the gaps between recommendations of guidelines for the management of ST-elevation myocardial infarction (STEMI) and treatment in clinical practice. Participation in continuous STEMI registries with benchmarking reports to the centres might improve implementation of guidelines into practice.
Methods: Between 1994 and 2008, 37,876 consecutive patients with STEMI were enrolled into the MI-registries MITRAplus and OPTAMI to document patients’ characteristics, acute treatment and outcome in clinical practice. We examined the impact of guideline adherence for acute treatment of STEMI including reperfusion as well as adjunctive medical treatment on hospital outcome over time in Germany 1994 –2008.
Results: From 1994 to 2008, the rate of acute reperfusion therapy in Germany increased from minimal 49% to 90% of consecutive patients with STEMI in 2008 with a significant shift from fibrinolysis to primary PCI. In parallel, the use of adjunctive medical treatment with aspirin, beta-blockers, ACE-inhibitors and clopidogrel was significantly improved over time. This improvement of guideline adherence for the acute treatment of STEMI was associated with a significant reduction of hospital mortality from initially 16.2% in 1994 to 6.2% in 2008.
Limitation: In the currently conducted OPTAMI-Registry, 84% of participating centres provide 24h PCI-service. The data from 2006 –2008 therefore reflects the treatment and outcome of STEMI in tertiary centres in Germany, but clearly demonstrates that implementation of current practice guidelines is feasible.
Conclusion: The improvements of guideline adherence for the management of STEMI, especially the increased rates of primary PCI as well as acute adjunctive medical treatment were associated with a significant decrease of hospital mortality in clinical practice in Germany.