Over the last two decades several new treatments, both pharmacological and mechanical, have become available for the treatment of ST-elevation myocardial infarction (STEMI). As a result, several rounds of national and international guidelines have been developed to guide the implementation of these evidence-based treatments in clinical practice. However, relatively few data are available on how implementation of such guidelines has influenced clinical outcomes.
Using data from the RIKS-HIA registry (The Register of Information and Knowledge about Swedish Heart Intensive Care Admission), Jernberg et al. examined the adoption of new treatments and the related chances of short- and long-term survival in consecutive patients with STEMI over a 12-year period. The main outcome measures were the estimated and crude proportions of patients treated with different medications and invasive procedures, and mortality over time.
The authors noted an increase in evidence based treatments: reperfusion increased from 66% to 79% and primary percutaneous coronary intervention from 12% to 61% (P<.001). In addition aspirin, clopidogrel, beta-blocker, statin and clopidogrel use all increased. Estimated mortality rates decreased over the same period of time: estimated in-hospital mortality fell from 12.5% to 7.2%, while one-year mortality fell from 21% to 13.3% (P<.001). This trend towards lower mortality continued after adjustment.
In this Swedish registry study, an increase in the prevalence of evidence-based treatments for STEMI was associated with a decrease in mortality that was sustained over 12 years.
- Jernberg T, Johanson P, Held C et al. Association Between Adoption of Evidence-Based Treatment and Survival for Patients With ST-Elevation Myocardial Infarction. JAMA 2011; 305:1677-1684.