Evidence-based treatments for ST-elevation MI associated with reduced mortality

Share this article:
Level 2: Mid-level evidence

In recent years, a number of evidence-based interventions for cardiovascular disease have been incorporated into clinical practice guidelines. A recent nationwide study in Sweden analyzed a cohort of 61,238 consecutive patients (mean age 70 years) with first-time ST-elevation MI (STEMI) from 1996 through 2007. Over this time period, significant increases in the use of evidence-based procedures and medications were accompanied by significant decreases in mortality.

Primary percutaneous coronary intervention rates increased from 12% to 61%, reperfusion rates (either mechanical or pharmacologic) increased from 66% to 79% and revascularization rates increased from 10% to 84%.

Rates of medication use increased from 0% to 82% for clopidogrel, 23% to 83% for statins and 39% to 69% for ACE inhibitors and angiotensin II receptor blockers (P <0.001 for each). Use of aspirin, beta blockers, and calcium channel blockers was also significantly increased.

Over the same period, mortality dropped significantly. In-hospital mortality fell from 12.5% to 7.2%, 30-day mortality from 15% to 8.6% and 1-year mortality from 21% to 13.3% (P for trend <0.001 for each; JAMA. 2011;305:1677-1684).

Alan Ehrlich, MD, is an assistant clinical professor in family medicine at the University of Massachusetts Medical School in Worcester.

Share this article:
You must be a registered member of Clinical Advisor to post a comment.

More in Evidence-Based Medicine

No benefit with arthroscopic surgery for knee OA

No benefit with arthroscopic surgery for knee OA

Arthroscopic partial meniscectomy does not improve degenerative medial meniscus tear symptoms in patients without knee osteoarthritis.

Steroid dose increase after CRS unnecessary to prevent hypotension

Steroid dose increase after CRS unnecessary to prevent ...

No difference in hypotension between low-, high-dose steroids for IBD patients undergoing major colorectal surgery.

Benefits of newer drug-eluting stents in women with CAD

Benefits of newer drug-eluting stents in women with ...

Newer-generation drug-eluting stents reduce MI risk, target revascularization in women with coronary artery disease.