Navigation Links
30-day mortality after AMI drops with improved treatment
Date:8/28/2012

The analysis of four French registries from 1995 to 2010 was presented by Professor Nicolas Danchin from the Hopital Europen Georges Pompidou.

Cardiologists recognize two types of myocardial infarction. The first type, ST-elevation myocardial infarction (STEMI), corresponds to the sudden, permanent occlusion of a coronary artery supplying the myocardium (cardiac muscle), usually manifesting as a prolonged, intense chest pain (what is known as a heart attack); it is a true medical emergency, as prompt reopening of the occluded artery will lead to myocardial salvage and limit the consequences of infarction. The second type, non-ST-segment elevation infarction (NSTEMI), is caused by partial or intermittent blockage of an artery, and leads to a more progressive and more limited destruction of myocardial cells; it does not usually require immediate coronary intervention.

"Over the past 15 years, the global picture of acute myocardial infarction has undergone profound changes," said Professor Danchin. "First, improvements in biological techniques have led to an easier recognition of myocardial cell death, thereby increasing the number of patients with documented myocardial necrosis (i.e. myocardial infarction) considered to have NSTEMI. Second, major changes in patient management have been implemented, following the results of numerous clinical trials in patients with myocardial infarction."

Every five years since 1995 in France, nationwide surveys of patients admitted to intensive care units for acute myocardial infarction during a one-month period have been implemented. Using data from the four registries from 1995 to 2010, the researchers sought to determine: 1) potential changes in the population of patients with heart attacks; 2) changes in their management; and 3) changes in clinical outcomes.

In all, 10,610 patients participated (1995: 2,152; 2000: 2,320; 2005: 3,059; 2010: 3,079). The proportion of patients with NSTEMI (1995: 29%; 2000: 21%; 2005: 47%; 2010 44%) increased after 2000 because of the generalized use of troponin measurements to detect myocardial necrosis (see figure 1). "Previously these patients would have been considered to have unstable angina," said Professor Danchin. "The distinction is important because unstable angina usually carries a lower risk than NSTEMI."

Mean age from 1995 to 2010 remained stable in NSTEMI patients (68 years) and decreased from 66 to 63 years in STEMI patients. From 1995 to 2010 there were increases in the prevalence of obesity (14% to 22%), diabetes (17% to 21%), hypertension (46% to 54%), current smoking (31% to 34%) and hypercholesterolemia (36% to 43%). "Overall, the patient risk profile is less severe in 2010 than in 1995 for both STEMI and NSTEMI patients, although several of the most common risk factors for developing coronary artery disease increased during this time period," said Professor Danchin.

The initial severity of infarction declined progressively, in particular with fewer patients having signs of heart failure. Professor Danchin said: "This could be because of the efficacy of primary prevention in patients with previously recognised risk factors, or secondary prevention in patients with known coronary artery disease."

Major changes in management were noted across all types of myocardial infarction. From 1995 to 2010 the use of percutaneous coronary intervention (PCI) increased from 12.5% to 65% in NSTEMI and from 19.5% to 87% in STEMI. In STEMI, the use of emergency reperfusion therapy to reopen the blocked artery increased from 49% to 75%; primary PCI increased from 12% to 60% and fibrinolysis decreased from 37% to 14%. Early use of evidence based medication increased (antiplatelet agents 91% to 97%, beta-blockers 64% to 81%, statins 14 to 90% and ACE inhibitors 46% to 60%). "This shows that the management of all patients with myocardial infarction has improved, with increasing use of recommended interventions and drug therapies," said Professor Danchin.

Thirty-day mortality dropped during 1995 to 2010 from 12.9% to 3.9% for all acute myocardial infarction patients. It fell from 13.7% to 4.4% in STEMI patients and 10.9% to 3.2% in NSTEMI patients (see figure 2). All in-hospital complications significantly decreased.

"Our analysis shows that the early mortality of both STEMI and NSTEMI patients has considerably decreased over the past 15 years," said Professor Danchin. "Our results suggest that the decreases in 30-day mortality and in-hospital complications are due to both the widespread use of coronary angiography/PCI, and earlier use of recommended medications, and the change in overall clinical presentation of the patients resulting in a decreased intrinsic risk.


'/>"/>

Contact: European Society of Cardiology
press@escardio.org
33-049-294-8627
European Society of Cardiology
Source:Eurekalert

Related medicine news :

1. Daily aspirin usage associated with lower cancer mortality
2. Study adds to evidence daily aspirin linked to lower cancer mortality
3. Lowering the national ozone standard would significantly reduce mortality and morbidity
4. Liver stiffness predicts liver failure, cancer and mortality in cirrhotic patients
5. New CDC study on racial disparities in infant mortality published in Journal of Womens Health
6. Single embryo transfer reduces the risk of perinatal mortality in IVF
7. Unemployed Americans face greater risk of mortality: UBC study
8. Antidepressant use associated with increased mortality among critically ill patients?
9. Tuberculosis increases the risk of lung cancer mortality in the elderly
10. UW study: Sleep apnea associated with higher mortality from cancer
11. Sleep disordered breathing is associated with an increased risk of cancer mortality
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:2/10/2016)... ... 2016 , ... AHRA: The Association for Medical Imaging Management ... will serve as keynote speaker at the organization’s 2016 Spring Conference. Fox’s topic, ... effectively communicate with their own organizational staff and leadership. , “I am ...
(Date:2/10/2016)... ... February 10, 2016 , ... The Club ... awarded the prestigious Distinguished Emerald Club of the World award, as determined by ... one of the most respected trade publications serving private clubs. , “We’d like ...
(Date:2/10/2016)... Petaluma, CA (PRWEB) , ... February 10, 2016 , ... ... newest and most versatile series of monitor mounts ever. , “Our goal was ... flexible and easy to install system that we have ever created.” said Darren Hulsey, ...
(Date:2/10/2016)... ... ... A new leadership team for Mid-South Youth Camp, operated by Freed-Hardeman University, will ... night, Feb. 8, prior to the evening session of the university’s 80th Annual Bible ... Camp, has been named director. Gayle McDonald, currently the assistant director of MSYC, will ...
(Date:2/10/2016)... ... February 09, 2016 , ... Traumatic Brian Injury ... injury may be one of many possible sources: sports, car accidents, falls, work ... , Mastering Rehab Solutions for the Complexities of Concussions is designed ...
Breaking Medicine News(10 mins):
(Date:2/10/2016)... 10, 2016 CERS ), Medivation, Inc. ... ) and Celldex Therapeutics, Inc. (NASDAQ: CLDX ). ... Adamas Pharmaceuticals, Inc. (NASDAQ: ADMS ) and Celldex Therapeutics, ... Orphan Drug Designations become vitally important in the development of ... drugs and biologics which are defined as those intended for ...
(Date:2/10/2016)... /PRNewswire/ - The President of New Venture Medical, ... an anti-radiation product from their Research and Development ... treatment of cancer using radiation and the treating ... the healing of radiation burns, even when open ... the healthy cells from radiation damage. It selectively ...
(Date:2/10/2016)... , Feb. 10, 2016  Silicon Biosystems Menarini ... products that help uncover the biological complexities of ... Inc., a developer of innovative technologies for genomics ... partnership aimed at enabling translational researchers to obtain ... couple hundred tumor and normal cells in an ...
Breaking Medicine Technology: