By Piriya Mahendra, medwireNews Reporter
An analysis of four French registries has shown a dramatic drop in ST-segment-elevation myocardial infarction (STEMI) mortality from 1995 to 2010, accompanied by a significant change in patient characteristics.
The authors say that while the reduction in mortality has been paralleled by improvements in care, such as greater use of angioplasty and adjunctive therapies, their findings indicate it is also partly due to changes in patient risk profile - specifically an increase in the proportion of young people included in these registries.
Nicolas Danchin (Hôpital Européen Georges Pompidou, Paris, France) and colleagues found that crude 30-day mortality in STEMI patients admitted to intensive care or coronary care units in France decreased from 13.7% in 1995 to 4.4% in 2010, while standardized mortality decreased from 11.3% to 4.4%.
After controlling for clinical characteristics, population risk score, and use of reperfusion therapy, multivariate analysis revealed a steady reduction in 30-day mortality over the study period. Compared with 1995, the odds ratios for death were 0.64, 0.52, and 0.39 in 2000, 2005, and 2010, respectively.
"The evolution of mortality was absolutely striking," said Danchin during a press briefing before the presentation of the study at the European Society of Cardiology Congress in Munich, Germany.
The mean age of patients admitted to intensive care or coronary care during the 15-year study period declined from 66.2 years to 63.3 years. This was primarily explained by a substantial increase in the proportion of younger patients (<60 years) being admitted, particularly among women - from 11.8% to 25.5%.
Danchin et al also noticed that both the prevalence of current smoking and obesity increased in women over time, from 37.3% to 73.1% and from 17.6% to 27.1%, respectively.
Speaking to medwireNews, Danchin explained: "I think that the first important message in my mind is that everyone should be aware that younger women are now at risk of developing an MI.
"There is a very, very strong link with smoking and, to a lesser extent, with obesity. In terms of public health, we should really focus our attention on this group of people now - that is the younger women."
Former ESC President, Michel Bertrand (Lille Heart Institute, France), told medwireNews that the main culprit for MI in young women is the combination of the contraceptive pill and smoking.
"In my life, I have been obliged several times to indicate heart transplantation in women. I remember one of them was 23 [years old] due to a big MI that completely destroyed the left ventricle... The Pill by itself is not dangerous, but the combination of the Pill and smoking is really dynamite, it's really a big bomb."
Other findings from the study included an increase over time in reperfusion therapy, from 49.4% to 74.7%. This was driven by primary percutaneous coronary intervention, which increased from 11.9% to 60.8%.
Early use of recommended medications, particularly low-molecular-weight heparins and statins, also increased from 24.7% to 62.3% in 2000-2010 and from 9.8% to 89.9% in 1995-2010, respectively.
Patients reacted more quickly to chest pain in 2010 than in 2000, taking 74 minutes to make the first call to emergency services after experiencing chest pain compared with 120 minutes in 2000. This shows that "patients are more aware of the potential cardiac origin of their chest pain," concluded study discussant Filippo Crea from the Universidad Católica Santo Domingo in the Dominican Republic.
The study findings were released in JAMA to coincide with their presentation at the Congress.
JAMA 2012 ; Advance online publication
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