Abstract 13780: Improved Outcomes in Medically-managed Patients With Acute Myocardial Infarction. Data From the 15-year FAST-MI programme
Background: invasive strategy is considered the main determinant of improved clinical outcomes in patients with acute myocardial infarction (AMI). Whether outcomes have also improved in medically-managed AMI patients remains an open question.
Patients and methods: We used data from 4 one-month nationwide French surveys from 1995 to 2010 (FAST-MI programme) to analyse survival in AMI patients without myocardial revascularization by PCI or CABG.
Results: 10,610 patients were included, with 4,295 (40%) managed medically. The % of medically-managed decreased from 82% (1995) to 39% (2000), 33% (2005) and 20% (2010). Among those, % of elderly (≥ 75 years) rose from 36% to 50%, and % of women from 31% to 41% (P<0.001). Diabetes increased from 18% to 28%, obesity from 14% to 21%, hypertension from 47% to 63% and hypercholesterolemia from 35% to 45%, while current smoking decreased from 28% to 18% (all P <0.001). History of prior MI rose from 19% to 27% but history of heart failure was unchanged (11% to 10%, P=0.34). Use of new anticoagulants (low molecular weight heparin, fondaparinux or bivalirudin) instead of unfractionated heparin alone increased from nil to 64% and appropriate early medications (i.e. statins and antiplatelet agents for all, beta-blockers and ACE-i/ARBs when indicated) from 6% to 45% (P<0.001). Crude 30-day mortality decreased from 14.0% to 9.1% (P<0.01), and crude 1-year death remained unchanged from 20.5% to 20.9%. After multivariate adjustment on baseline characteristics, both 30-day (OR = 0.49; 95%CI: 0.33-0.73) and 1-year mortality (HR = 0.74; 0.57-0.96) were significantly lower in 2010 vs 1995. When new anticoagulants and appropriate medical therapy were added to the multivariate model, however, 30-day (OR=0.86; 0.56-1.33) and one-year mortality (HR=1.14; 0.86-1.51) no longer differed for 2010 compared with 1995, while new anticoagulants (OR 0.48; 0.35-0.65, HR 0.61; 0.51-0.74) and appropriate medical therapy (OR 0.43; 0.30-0.64, HR 0.52; 0.41-0.66) were strongly related to outcomes.
Conclusion: 30-day and one-year outcomes of AMI patients managed medically have improved in the last 15 years. Most of this improvement can be attributed to early use of recommended medical therapy and new anticoagulants instead of unfractionated heparin.
- © 2013 by American Heart Association, Inc.