Temporal trends in outcomes of patients suffering from ST-Segment elevation myocardial infarction

Background: Despite recent advancements in coronary artery disease (CAD) treatment, ST-segment elevation myocardial infarction (STEMI) remains a high-risk medical condition. Assessment of recent STEMI patient outcomes, treated with primary percutaneous coronary intervention (pPCI), after implementation of the 2013 ESC STEMI guidelines, is lacking. Methods: The study was based on a prospective registry of 3002 consecutive patients with STEMI treated to our tertiary medical center. We compared trends during two different time periods (2006-2012, 2012-2018). Endpoints included mortality and major adverse cardiac events [MACE: death, myocardial infarction (MI), target vessel revascularization (TVR), and coronary artery bypass surgery (CABG)] at 1 month 1 year and 2 years. Results: There was no significant difference in age (p=0.19), sex (p=0.82), diabetes (p=0.35) or renal failure (p=0.9) rates between the two groups. Rates of transradial approach have risen significantly (67.3 vs. 42.0%, p<0.01), as were rates of Prasugrel administration (69.8% vs. 0.0%, p<0.01). Both at 1 month and at 2 years, MACE was significantly lower in the second period (4.5 vs. 9.6%, ppp<0.01) but not after 2 years (8.4 vs. 10.5%, p=0.13). Cox regression identified the 2^nd period to independently impact MACE (HR- 0.69, 95%CI 0.56-0.85, p<0.01) but not mortality (HR- 0.76, 95%CI 0.54-1.05, p=0.09). Conclusion: Among patients treated with pPCI for STEMI, adoption of evidence-based treatments is associated with better outcomes, following the inception of the 2013 guidelines.