Temporal trends in mortality after ST-segment elevation myocardial infarction in the acute coronary syndrome Israeli survey (ACSIS) 2000-2013

Background: Thirty-day case-fatality rates in patients with ST-segment elevation myocardial infarction (STEMI) declined in Israel during the last decades, but long-term mortality trends remain elusive.

Aim: To examine two-year all-cause and cause-specific mortality trends in consecutive ACSIS patients diagnosed with STEMI.

Methods: Patient demographics, admission characteristics, prior medical history, and in-hospital management were drawn from ACSIS 2000-2013 database. All-cause and cause-specific mortality data were obtained from the Israel Center for Disease Control. Survival models were used to assess temporal trends in all-cause and cause-specific mortality; spline methodology was used to test for non-linear trends.

Results: Over 7 ACSIS cycles, 5830 patients were hospitalized with STEMI [mean (SD) age, 62 (13) years, 22% women]. Infarct severity declined over time and acute treatment improved. At two years of follow-up, 800 deaths were recorded. From 2000-2013, mortality rates declined initially, then leveled off around 2010 (P = .034 for nonlinear trend; Figure). In cause-specific analysis, CVD death rates declined initially and then plateaued, with no substantial change in non-CVD death rates, resulting in a shift in the distribution towards the latter (27% in 2000-2004 vs 43% in 2010-2013, P < .001).

Conclusions: The absence of further reduction in 2-year all-cause, and CVD- mortality after 2010 is concerning and should prompt more vigilant implementation of secondary prevention measures after STEMI.

Figure. Spline-based curve representing age- and sex-adjusted hazard ratios for mortality after STEMI by ACSIS cycle