10-Year Mortality After ST-Segment Elevation Myocardial Infarction Compared to the General Population.

BACKGROUND

ST-segment elevation myocardial infarction (STEMI) is associated with high early mortality. However, it remains unclear if patients surviving the early phase have long-term excess mortality.

OBJECTIVES

This study aims to assess excess mortality in STEMI patients treated with primary percutaneous coronary intervention (PCI) compared with an age- and- sex-matched general population at landmark periods 0 to 30 days, 31 to 90 days, and 91 days to 10 years.

METHODS

Using the Western Denmark Heart Registry, we identified first-time PCI-treated patients who had primary PCI for STEMI from January 2003 to October 2018. Each patient was matched by age and sex to 5 individuals from the general population.

RESULTS

We included 18,818 patients with first-time STEMI and 94,090 individuals from the general population. Baseline comorbidity burden was similar in STEMI patients and matched individuals. Compared with the matched individuals, STEMI was associated with a 5.9% excess mortality from 0 to 30 days (6.0% vs 0.2%; HR: 36.44; 95% CI: 30.86-43.04). An excess mortality remained present from 31 to 90 days (0.9% vs 0.4%; HR: 2.43; 95% CI: 2.02-2.93). However, in 90-day STEMI survivors, the absolute excess mortality was only 2.1 percentage points at 10-year follow-up (26.5% vs 24.5%; HR: 1.04; 95% CI: 1.01-1.08). Use of secondary preventive medications such as statins, antiplatelet therapy, and beta-blockers was very high in STEMI patients throughout 10-year follow-up.

CONCLUSIONS

In primary PCI-treated STEMI patients with high use of guideline-recommended therapy, patients surviving the first 90 days had 10-year mortality that was only 2% higher than that of a matched general population.

Informations de copyright

Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Funding Support and Author Disclosures The study was supported by a grant from Aase and Ejnar Danielsen’s Foundation. Dr Olesen has received grants from the Danish Cardiovascular Academy funded by the Danish Heart Association and Novo Nordisk. Dr Mortensen has received lecture fees from Novo Nordisk, Amgen, Sanofi, AstraZeneca, and Amarin. Dr Kristensen is national coordinating investigator in the SOS-AMI (Suspected Acute Myocardial Infarction) trial (Idorsia). Dr Maeng has received grants from the Novo Nordisk Foundation (grant number NNF22OC0074083); has received lecture and/or advisory board fees from AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, and Novo Nordisk; has received a travel grant from Novo Nordisk; has received institutional research grants from Philips, Bayer, and Novo Nordisk; has ongoing research contracts with Janssen, Novo Nordisk, and Philips; and is a minor shareholder in Novo Nordisk, Eli Lilly and Company, and Verve Therapeutics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.