FAST-MI programme: Decrease in early mortality in STEMI is related to changing patient profile and behavior, as well as improved organization of care: Data from 4 French nationwide surveys ov
List of Authors:
Prof. Nicolas Danchin / France
Etienne Puymirat, MD/Philippe-Gabriel Steg, MD, PhD/Khalife Khelife, MD/Pascal Gueret, MD, PhD/Didier Blanchard, MD/Jean-Pierre Cambou, MD/Jean Ferrières, MD, PhD/Tabassome Simon, MD, PhD
Background & aim
Registries have shown a decline in mortality in patients with ST-elevation myocardial infarction (STEMI), which is often attributed to increased use of reperfusion therapy. We used the data from 4 nationwide French surveys conducted 5 years apart from 1995 to 2010 to assess the association between early mortality and patient profile, initial behavior, as well as organization of medical care.
USIK 1995, USIC 2000, FAST-MI 2005 and FAST-MI 2010 all included patients with STEMI < 48 hours from symptom onset, over a one-month period of time in a large number of French cardiology centres (60 to 80% of all centres taking care of STEMI patients). In all, 6,704 patients participated (1995: 1,536; 2000: 1,841; 2005: 1,611; 2010: 1,716).
From 1995 to 2005, mean age declined from 66 ± 14 to 63 ± 15 years (P < 0.001); there was an increase in obesity (14% to 21%; P < 0.001), smoking (32% to 41%; P < 0.001) and hypertension (44% to 47%; P=0.01). History of MI (15% to 11%), peripheral artery disease (10% to 5%) and stroke (6% to 4%) decreased. Median time from onset to first call decreased from 120 to 74 minutes (P < 0.001), and use of MICU (SAMU) increased from 55% to 81.5% (P < 0.001). Reperfusion therapy use increased from 49% to 80%, with a decrease in lysis (37.5% to 15%) and an increase in primary PCI (12% to 65%). Early use of antiplatelet agents (92 to 97%), LMWH (27% to 62%), beta-blockers (65% to 81%), ACE-I (48 to 60%), statins (10% to 90%), increased and UFH decreased (96% to 45%). All complications decreased (shock: 7.4 to 4.7%, recurrent MI: 2.6% to 1.0%, VF: 4.2% to 2.7%, AF: 12.5% to 5.6%). Thirty-day mortality decreased from 13.7% to 4.5%. Mortality decreased irrespective of use and type of reperfusion therapy: no reperfusion (18.9% to 10.4%), lysis (8.2% to 2.1%), PPCI (8.7% to 3.1%). Multivariate analysis confirmed that overall management was strongly related to mortality.
these results show that mortality in STEMI patients decreased in a spectacular way, resulting from increased use of reperfusion therapy but also from changing patients characteristics, changing behavior, and better overall organization of care.