Revascularized ST-segment elevation myocardial infarction. Temporal trends in contemporary therapies and impact on outcomes.

Autor: Ribera A; Servicio de Cardiología, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain. Electronic address: aida.ribera@vhir.org., Marsal JR; Servicio de Cardiología, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain., Faixedas MT; Servei Català de la Salut, Barcelona, Spain., Rosas A; Departament de Salut, Generalitat de Catalunya, Barcelona, Spain., Tizón-Marcos H; Servicio de Cardiología, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain., Rojas S; Servicio de Cardiología, Hospital Universitari de Tarragona Joan XXIII, IISPV, Universidad Rovira Virgili, Tarragona, Spain., Labata C; Servicio de Cardiología, Hospital German Trias i Pujol, Barcelona, Spain., Cárdenas M; Servicio de Cardiología, Hospital Josep Trueta, Girona, Spain., Homs S; Servicio de Cardiología, Hospital Mútua de Terrassa, Terrassa, Barcelona, Spain., Tomás-Querol C; Servicio de Cardiología, Hospital Arnau de Vilanova, Lleida, Spain., García-Picart J; Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain., Roura G; Servicio de Cardiología, Hospital de Bellvitge, Barcelona, Spain., Masotti M; Servicio de Cardiología, Hospital Clínic, Barcelona, Spain., Mauri J; Servicio de Cardiología, Hospital Universitari de Tarragona Joan XXIII, IISPV, Universidad Rovira Virgili, Tarragona, Spain., Pijoan JI; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain; Unidad de Epidemiología Clínica, Hospital Universitario Cruces/Instituto de Investigación BioCruces-Bizkaia, Barakaldo, Bizkaia, Spain., Barrabés JA; Servicio de Cardiología, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain., Ferreira-González I; Servicio de Cardiología, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain.
Jazyk: English; Spanish; Castilian
Zdroj: Revista espanola de cardiologia (English ed.) [Rev Esp Cardiol (Engl Ed)] 2022 Aug; Vol. 75 (8), pp. 659-668. Date of Electronic Publication: 2021 Dec 06.
DOI: 10.1016/j.rec.2021.10.011
Abstrakt: Introduction and Objectives: To assess, in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous intervention, the pace of introduction in clinical practice (2010-2017) of drug-eluting stents (DES), ticagrelor, prasugrel, and prolonged dual antiplatelet therapy (DAPT) duration, and their potential impact on the risk of 2-year outcomes.
Methods: Prospective and exhaustive community-wide cohort of 14 841 STEMI patients undergoing primary percutaneous intervention between 2010 and 2017. Index episodes were obtained from the Catalan Codi IAM Registry, events during follow-up from the Minimum Data Set and DAPT were defined by pharmacy dispensation. Follow-up was 24 months. The temporal trend for exposures and outcomes was assessed using regression models.
Results: Age> 65 years, diabetes, renal failure, previous heart failure, and need for anticoagulation at discharge were more frequent in later periods (P <.001). From 2010 to 2017, the use of DES increased from 31.1% to 69.8%, ticagrelor from 0.1% to 28.6%, prasugrel from 1.5% to 23.8%, and the median consecutive months on DAPT from 2 to 10 (P <.001 for all). Adjusted analysis showed a temporal trend to a lower risk of the main outcome over time: the composite of death, acute myocardial infarction, stroke and repeat revascularization (absolute odds reduction 0.005% each quarter; OR, 0.995; 95%CI, 0.99-0.999; P=.028). The odds of all individual components except stroke were reduced, although significance was only reached for revascularization.
Conclusions: Despite a strong increase between 2010 and 2017 in the use and duration of DAPT and the use of ticagrelor, prasugrel and DES, there was no substantial reduction in major cardiovascular outcomes.
(Copyright © 2021 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: