Temporal changes in patient characteristics and outcomes in ST-segment elevation myocardial infarction 2003–2018
Corresponding Author
Santiago Garcia MD
Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
Correspondence
Santiago Garcia, MD, Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
Email: [email protected]
Search for more papers by this authorChristian W. Schmidt MPH
Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
Search for more papers by this authorRoss Garberich MS, MBA
Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
Search for more papers by this authorTimothy D. Henry MD
The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio, USA
Search for more papers by this authorSteven M. Bradley MD, MPH
Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
Search for more papers by this authorEmmanouil S. Brilakis MD, PhD
Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
Search for more papers by this authorNickolas Burke MD
Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
Search for more papers by this authorIvan J. Chavez MD
Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
Search for more papers by this authorPeter Eckman MD
Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
Search for more papers by this authorMario Gössl MD, PhD
Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
Search for more papers by this authorMichael R. Mooney MD
Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
Search for more papers by this authorMarc C. Newell MD
Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
Search for more papers by this authorAnil K. Poulose MD
Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
Search for more papers by this authorPaul Sorajja MD
Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
Search for more papers by this authorJay H. Traverse MD
Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
Search for more papers by this authorYale L. Wang MD
Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
Search for more papers by this authorScott W. Sharkey MD
Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
Search for more papers by this authorCorresponding Author
Santiago Garcia MD
Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
Correspondence
Santiago Garcia, MD, Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
Email: [email protected]
Search for more papers by this authorChristian W. Schmidt MPH
Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
Search for more papers by this authorRoss Garberich MS, MBA
Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
Search for more papers by this authorTimothy D. Henry MD
The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio, USA
Search for more papers by this authorSteven M. Bradley MD, MPH
Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
Search for more papers by this authorEmmanouil S. Brilakis MD, PhD
Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
Search for more papers by this authorNickolas Burke MD
Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
Search for more papers by this authorIvan J. Chavez MD
Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
Search for more papers by this authorPeter Eckman MD
Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
Search for more papers by this authorMario Gössl MD, PhD
Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
Search for more papers by this authorMichael R. Mooney MD
Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
Search for more papers by this authorMarc C. Newell MD
Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
Search for more papers by this authorAnil K. Poulose MD
Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
Search for more papers by this authorPaul Sorajja MD
Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
Search for more papers by this authorJay H. Traverse MD
Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
Search for more papers by this authorYale L. Wang MD
Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
Search for more papers by this authorScott W. Sharkey MD
Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
Search for more papers by this authorAbstract
Background
We sought to describe changes in demographic variables, process of care measures, and outcomes of patients treated in a regional ST-segment elevation myocardial infarction (STEMI) program over the last 15 years.
Methods
We describe demographic variables, process of care measures, and outcomes of patients treated in the program in various 5-year time periods: 2003–2007 (n = 1,821), 2008–2012 (n = 1,968), and 2013–2018 (n = 2,223). The primary outcome measures were in-hospital and 30-day mortality.
Results
Among 6,012 STEMI patients treated from 2003 to 2018 we observed a significant increase in mean age at presentation (62 ± 14 to 64 ± 13 years) and diabetes (14–22%, p < .01). The proportion of patients with cardiogenic shock (CS) and cardiac arrest (CA) pre-PCI increased significantly from 9.5% to 11.1% and 8.5% to 12.7% (p < .05), respectively. The median door-to-balloon (D2B) times decreased from 98 to 93 min and total ischemic time decreased from 202 to 185 min (all p < .05). Despite increased patient complexity, the proportion of nontransfer and transfer patients achieving D2B times consistent with guideline recommendations remained unchanged (for nontransfer patients 79–82%, p = .45 and for transfer patients 65–64%, p = .34). Among all STEMI patients, in-hospital mortality increased during the study period from 4.9 to 6.9% (p = .007) but remained stable (<2%) when CA and CS patients were excluded.
Conclusions
Over the last 15 years, short-term STEMI mortality has increased despite improvements in care delivery metrics. Patients with CA and/or CS now represent 10% of STEMI patients and are responsible for 80% of deaths. Therefore, efforts to improve STEMI mortality, and metrics for assessing STEMI programs, should focus on these patients.
Supporting Information
| Filename | Description |
|---|---|
| ccd28901-sup-0001-Supinfo1.docxWord 2007 document , 19.7 KB | Appendix S1: Supporting Information |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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