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

Co-authors: 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.

Methods
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).

Results
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.

Conclusion
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. 


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