Adoption of evidence-based therapies associated with increased survival of STEMI patients

Key Points

In a recently published observational registry study, researchers have demonstrated that the utilization of evidence-based therapies in patients experiencing ST-elevation myocardial infarction (STEMI) is on the rise; and further, this increased utilization is likely resulting in a gradual lowering of both short- and long-term mortality.

These findings from the SWEDEHEART/RIKS-HIA (the Register of Information and Knowledge about Swedish Heart Intensive Care Administration) investigators were published in a recent edition of the Journal of the American Medical Association.

According to the authors, "Only limited information is available on the speed of implementation of new evidence-based and guideline-recommended treatments and its association with survival in real life health care of patients with STEMI."

CLOPIDOGREL USE INCREASES

In respect to evidence-based drug therapy, researchers found that the use of aspirin, clopidogrel, beta-blockers, statins, angiotensin-converting enzyme (ACE) inhibitors, and glycoprotein IIb/IIIa inhibitors all statistically significantly increased over the study period. Most notably, use of clopidogrel increased from 0% to 82%, statins from 23% to 83%, and ACE inhibitor or angiotensin II receptor blockers from 39% to 69%.

In addition to the above evidence-based drug therapies, revascularization [bypass surgery or percutaneous coronary intervention (PCI)] and reperfusion (primary PCI or thrombolysis) strategies increased as well.

The investigators did note, "However, large variations existed between hospitals regarding the speed of implementation of new treatments."

Interestingly, major adverse cardiovascular events and mortality decreased over the same period of time. For example, the proportion of patients experiencing a new myocardial infarction dropped from 4% to 1%; hospital length-of-stays decreased, and estimated in-hospital, 30-day, and 1-year mortality decreased from 12.5% to 7.2%, 15.0% to 8.6%, and 21.0% to 13.3%, respectively (P<.001 for all). Moreover, the 12-year survival analyses showed that the observed decrease in mortality was sustained over time.

"...the improvement of outcome can be expressed as an average gain of at least 2.7 years of life in patients with STEMI in 2007 compared with 12 years earlier," the investigators noted.

While causality cannot be proven, the benefits seen in regard to cardiovascular outcomes reflect at least in part the greater utilization of evidence-based strategies by healthcare professionals, the authors concluded.