Evidence-Based Therapies for ST-Segment-Elevation Myocardial Infarction Improve Survival

A national registry in Sweden captures comprehensive data on the evolution of STEMI treatment and outcomes.

Several reports have described trends in therapy and outcomes in patients with myocardial infarction (MI), but few have included unrestricted populations. This study focuses on trends in evidence-based therapies and mortality in 61,238 patients who had a first-time diagnosis of ST-segment-elevation MI (STEMI) at acute cardiac care hospitals throughout Sweden from 1996 through 2007.


Over the study period, the mean age of the STEMI patients decreased from 71 to 69; rates of baseline hypertension and cigarette use increased; and the proportions taking statins, angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs), or both at admission increased. The rate of fibrinolysis declined from 66% in 1996–1997 to 7% in 2006–2007, with concomitant increases in the rates of angiography (from 12% to 93%) and primary percutaneous coronary intervention (from 12% to 61%). Rates of guideline-recommended medication use, including aspirin, clopidogrel, beta-blockers, ACE inhibitors or ARBs, and statins, increased significantly over time, and hospital-to-hospital variability in the use of all of these medications except ACE inhibitors or ARBs narrowed. Mortality at 1 year, standardized for differences in baseline patient characteristics, decreased substantially, from 19.0% in 1996 to 11.2% in 2007.


Citation(s):

Jernberg T et al. for SWEDEHEART/RIKS-HIA. Association between adoption of evidence-based treatment and survival for patients with ST-elevation myocardial infarction. JAMA 2011 Apr 27; 305:1677.

Mukherjee D. Implementation of evidence-based therapies for myocardial infarction and survival. JAMA 2011 Apr 27; 305:1710.