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Temporal trends in latecomer STEMI patients: insights from the AMIS Plus registry 1997-2017

Marco Roberto, Dragana Radovanovic, Edoardo De Benedetti, Luigi Biasco, Geza Halasz, Angelo Quagliana, Paul Erne, Hans Rickli, Giovanni Pedrazzini & Marco Moccetti

abstract

INTRODUCTION AND OBJECTIVES
A substantial proportion of patients experiencing ST-segment elevation myocardial infarction (STEMI) have a late presentation. There is a lack of temporal trends drawn from large real-word scenarios in these patients.

METHODS
All STEMI patients included in the AMIS Plus registry from January 1997 to December 2017 were screened and patient-related delay was assessed. STEMI patients were classified as early or latecomers according to patient-related delay (≤ or> 12hours, respectively).

RESULTS
A total of 27 231 STEMI patients were available for the analysis. During the study period, the prevalence of late presentation decreased from 22% to 12.3% (P <.001). In latecomer STEMI patients, there was a gradual uptake of evidence-based pharmacological treatments (rate of P2Y inhibitors at discharge, from 6% to 90.6%, P <.001) and a marked increase in the use of percutaneous coronary intervention (PCI), particularly in 12- to 48-hour latecomers (from 11.9%-87.9%; P <.001). In-hospital mortality was reduced from 12.4% to 4.5% (P <.001). On multivariate analysis, PCI had a strong independent protective effect on in-hospital mortality in 12- to 48-hour latecomers (OR, 0.29; 95%CI, 0.15-0.55).

CONCLUSIONS
During the 20-year study period, there was a progressive reduction in the prevalence of late presentation, a gradual uptake of main evidence-based pharmacological treatments, and a marked increase in PCI rate in latecomer STEMI patients. In-hospital mortality was reduced to a third (to an absolute rate of 4.5%); in 12- to 48-hour latecomers, this reduction seemed to be mainly associated with the increasing implementation of PCI.
   
citation Roberto M, Radovanovic D, De Benedetti E, Biasco L, Halasz G, Quagliana A, Erne P, Rickli H, Pedrazzini G, Moccetti M. Temporal trends in latecomer STEMI patients: insights from the AMIS Plus registry 1997-2017. Rev Esp Cardiol (Engl Ed) 2019;.
   
type journal paper/review (English)
date of publishing 03-12-2019
journal title Rev Esp Cardiol (Engl Ed)
ISSN electronic 1885-5857
PubMed 31810820
DOI 10.1016/j.rec.2019.10.001