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 is largely explained by improvements in care, their findings indicate it is also partly due to changes in patient risk profile ‑ specifically, an increase in the proportion of patients under 60 years old.
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.
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 authors say these findings could be attributed to improvements in care, such as an increase in reperfusion therapy and an increase in the early use of recommended medications, as well as patients seeking medical help faster for chest pain.
However, they also found that the mean age of patients declined from 66.2 years to 63.3 years. This was primarily due to a substantial increase in the proportion of younger patients (<60 years) being admitted, particularly women ‑ from 11.8% to 25.5%.
Danchin et al also noted 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."
The study findings were released in JAMA to coincide with their presentation at the Congress.
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