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Notable change in population characteristics and improved organisation of care lead to mortality reduction in STEMI patients

Comment by Eugenio Greco, EACPR Prevention, Epidemiology & Population Science Section

Decrease in early mortality in STEMI attributed to changing patient profile and behaviour, and improved organisation of care: Data from four French registries over 15 years.
European Society of Cardiology Congress; Munich, Germany: 25–29 August 2012
Press Release l Session
N. Danchin et al.


The results of this French study, presented by N. Danchin at the ESC Congress 2012 in Munich, showed a decrease by 68%, from 13.7% to 4.4%, in early mortality in STEMI (ST-elevation myocardial infarction) patients. Around one quarter of this mortality reduction could be attributed to a change in patient characteristics and improved organisation of care.

The study data was processed from four French nationwide registries of STEMI patients (French registries USIK 1995, USIC 2000, FAST-MI 2005 and FAST-MI 2010), covering more than 15 years.
The analysis did indeed show a notable change in population characteristics and improved organisation of care:

  • decrease in age;
  • lower proportion of patients with associated conditions or previously known heart disease;
  • increase in the proportion of younger patients (i.e., below 60 years of age), especially women, concomitant with an increased prevalence of smoking and obesity;
  • the behaviour of patients confronted with acute chest pain also changed, with a more rapid call for medical help;
  • more patients also received reperfusion therapy to reopen the blocked artery (75% in 2010, compared with 49% in 1995), with a five-fold increase in use of primary PCI (from 12% to 60%);
  • other changes were observed in the early management of STEMI patients, with more receiving antiplatelet agents or low molecular weight heparin to help dissolve the clot, as well as other recommended medications (particularly statins, whose use increased from 10% to 90%).

N. Danchin concluded that:
“... Spectacular progress has been made in the treatment of ST-elevation myocardial infarction, and most of this progress is generally attributed to the more frequent administration of reperfusion therapy, particularly by primary PCI... [but]... the major decline in early mortality for STEMI patients should not be attributed only to improved delivery of reperfusion treatment. The improvement also reflects a profound and preoccupying change in the type of patient having a heart attack, with a particular increase in the number of young women. This increase is concomitant with an increased prevalence of smoking and obesity".