Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

30-day mortality after AMI drops with improved treatment

29.08.2012
The analysis of four French registries from 1995 to 2010 was presented by Professor Nicolas Danchin from the Hopital Européen Georges Pompidou.

Cardiologists recognize two types of myocardial infarction. The first type, ST-elevation myocardial infarction (STEMI), corresponds to the sudden, permanent occlusion of a coronary artery supplying the myocardium (cardiac muscle), usually manifesting as a prolonged, intense chest pain (what is known as a heart attack); it is a true medical emergency, as prompt reopening of the occluded artery will lead to myocardial salvage and limit the consequences of infarction.

The second type, non-ST-segment elevation infarction (NSTEMI), is caused by partial or intermittent blockage of an artery, and leads to a more progressive and more limited destruction of myocardial cells; it does not usually require immediate coronary intervention.

"Over the past 15 years, the global picture of acute myocardial infarction has undergone profound changes," said Professor Danchin. "First, improvements in biological techniques have led to an easier recognition of myocardial cell death, thereby increasing the number of patients with documented myocardial necrosis (i.e. myocardial infarction) considered to have NSTEMI. Second, major changes in patient management have been implemented, following the results of numerous clinical trials in patients with myocardial infarction."

Every five years since 1995 in France, nationwide surveys of patients admitted to intensive care units for acute myocardial infarction during a one-month period have been implemented. Using data from the four registries from 1995 to 2010, the researchers sought to determine: 1) potential changes in the population of patients with heart attacks; 2) changes in their management; and 3) changes in clinical outcomes.

In all, 10,610 patients participated (1995: 2,152; 2000: 2,320; 2005: 3,059; 2010: 3,079). The proportion of patients with NSTEMI (1995: 29%; 2000: 21%; 2005: 47%; 2010 44%) increased after 2000 because of the generalized use of troponin measurements to detect myocardial necrosis (see figure 1). "Previously these patients would have been considered to have unstable angina," said Professor Danchin. "The distinction is important because unstable angina usually carries a lower risk than NSTEMI."

Mean age from 1995 to 2010 remained stable in NSTEMI patients (68 years) and decreased from 66 to 63 years in STEMI patients. From 1995 to 2010 there were increases in the prevalence of obesity (14% to 22%), diabetes (17% to 21%), hypertension (46% to 54%), current smoking (31% to 34%) and hypercholesterolemia (36% to 43%). "Overall, the patient risk profile is less severe in 2010 than in 1995 for both STEMI and NSTEMI patients, although several of the most common risk factors for developing coronary artery disease increased during this time period," said Professor Danchin.

The initial severity of infarction declined progressively, in particular with fewer patients having signs of heart failure. Professor Danchin said: "This could be because of the efficacy of primary prevention in patients with previously recognised risk factors, or secondary prevention in patients with known coronary artery disease."

Major changes in management were noted across all types of myocardial infarction. From 1995 to 2010 the use of percutaneous coronary intervention (PCI) increased from 12.5% to 65% in NSTEMI and from 19.5% to 87% in STEMI. In STEMI, the use of emergency reperfusion therapy to reopen the blocked artery increased from 49% to 75%; primary PCI increased from 12% to 60% and fibrinolysis decreased from 37% to 14%. Early use of evidence based medication increased (antiplatelet agents 91% to 97%, beta-blockers 64% to 81%, statins 14 to 90% and ACE inhibitors 46% to 60%). "This shows that the management of all patients with myocardial infarction has improved, with increasing use of recommended interventions and drug therapies," said Professor Danchin.

Thirty-day mortality dropped during 1995 to 2010 from 12.9% to 3.9% for all acute myocardial infarction patients. It fell from 13.7% to 4.4% in STEMI patients and 10.9% to 3.2% in NSTEMI patients (see figure 2). All in-hospital complications significantly decreased.

"Our analysis shows that the early mortality of both STEMI and NSTEMI patients has considerably decreased over the past 15 years," said Professor Danchin. "Our results suggest that the decreases in 30-day mortality and in-hospital complications are due to both the widespread use of coronary angiography/PCI, and earlier use of recommended medications, and the change in overall clinical presentation of the patients resulting in a decreased intrinsic risk.

Contributors:

N. Danchin, E. Puymirat, G. Steg, D. Blanchard, P. Goldstein, M. Hanssen, E. Durand, P. Gueret, T. Simon, JP. Cambou, on behalf of the USIK 1995, USIC 2000, FAST-MI 2005 and FAST-MI 2010 investigators

Notes to editors

Please note that picture and CV from the author, abstract, picture and CV from spokesperson can be found here.

About the European Society of Cardiology www.escardio.org

The European Society of Cardiology (ESC) represents more than 75,000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe.

About ESC Congress 2012

The ESC Congress is currently the world's premier conference on the science, management and prevention of cardiovascular disease. ESC Congress 2012 takes place 25-29 August at the Messe München in Munich. The scientific programme is available here.

More information is available from the ESC Press Office at press@escardio.org.

| EurekAlert!
Further information:
http://www.escardio.org

More articles from Health and Medicine:

nachricht Organ-on-a-chip mimics heart's biomechanical properties
23.02.2017 | Vanderbilt University

nachricht Researchers identify cause of hereditary skeletal muscle disorder
22.02.2017 | Klinikum der Universität München

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Breakthrough with a chain of gold atoms

In the field of nanoscience, an international team of physicists with participants from Konstanz has achieved a breakthrough in understanding heat transport

In the field of nanoscience, an international team of physicists with participants from Konstanz has achieved a breakthrough in understanding heat transport

Im Focus: DNA repair: a new letter in the cell alphabet

Results reveal how discoveries may be hidden in scientific “blind spots”

Cells need to repair damaged DNA in our genes to prevent the development of cancer and other diseases. Our cells therefore activate and send “repair-proteins”...

Im Focus: Dresdner scientists print tomorrow’s world

The Fraunhofer IWS Dresden and Technische Universität Dresden inaugurated their jointly operated Center for Additive Manufacturing Dresden (AMCD) with a festive ceremony on February 7, 2017. Scientists from various disciplines perform research on materials, additive manufacturing processes and innovative technologies, which build up components in a layer by layer process. This technology opens up new horizons for component design and combinations of functions. For example during fabrication, electrical conductors and sensors are already able to be additively manufactured into components. They provide information about stress conditions of a product during operation.

The 3D-printing technology, or additive manufacturing as it is often called, has long made the step out of scientific research laboratories into industrial...

Im Focus: Mimicking nature's cellular architectures via 3-D printing

Research offers new level of control over the structure of 3-D printed materials

Nature does amazing things with limited design materials. Grass, for example, can support its own weight, resist strong wind loads, and recover after being...

Im Focus: Three Magnetic States for Each Hole

Nanometer-scale magnetic perforated grids could create new possibilities for computing. Together with international colleagues, scientists from the Helmholtz Zentrum Dresden-Rossendorf (HZDR) have shown how a cobalt grid can be reliably programmed at room temperature. In addition they discovered that for every hole ("antidot") three magnetic states can be configured. The results have been published in the journal "Scientific Reports".

Physicist Dr. Rantej Bali from the HZDR, together with scientists from Singapore and Australia, designed a special grid structure in a thin layer of cobalt in...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Booth and panel discussion – The Lindau Nobel Laureate Meetings at the AAAS 2017 Annual Meeting

13.02.2017 | Event News

Complex Loading versus Hidden Reserves

10.02.2017 | Event News

International Conference on Crystal Growth in Freiburg

09.02.2017 | Event News

 
Latest News

Stingless bees have their nests protected by soldiers

24.02.2017 | Life Sciences

New risk factors for anxiety disorders

24.02.2017 | Life Sciences

MWC 2017: 5G Capital Berlin

24.02.2017 | Trade Fair News

VideoLinks
B2B-VideoLinks
More VideoLinks >>>