Long-term outcomes of extended DAPT in a real-life cohort of consecutive STEMI patients.

INTRODUCTION AND OBJECTIVES: Dual antiplatelet therapy (DAPT) duration after ST-segment elevation myocardial infarction (STEMI) remains a matter of debate. METHODS: We analyzed the effect of DAPT on 5-year all-cause mortality, cardiovascular mortality, and cardiovascular readmission or mortality in a cohort of 1-year survivor STEMI patients. RESULTS: A total of 3107 patients with the diagnosis of STEMI were included: 93% of them were discharged on DAPT, a therapy that persisted in 275 high-risk patients at 5 years. Cardiovascular mortality in patients on single antiplatelet therapy vs DAPT at 5 years was 1.4% vs 3.6% (P <.01), respectively, whereas noncardiovascular mortality was 3.3% vs 5.8% (P=.049) at 5 years. Cardiovascular readmission or mortality in patients with single antiplatelet therapy vs DAPT was 11.4% vs 46.5% (P <.001). Extended DAPT was independently associated with worse 5-year all-cause mortality (HR, 2.16; 95%CI, 1.40-3.33), cardiovascular mortality (HR, 2.83; 95%CI, 1.37-5.84), and cardiovascular readmission or mortality (HR, 5.20; 95%CI, 3.96-6.82). These findings were confirmed in propensity score matching and inverse probability weighting analyses. CONCLUSIONS: Our results suggest the hypothesis that, in 1-year STEMI survivors, extending DAPT up to 5 years in high-risk patients does not improve their long-term prognosis.

Benefit of primary percutaneous coronary interventions in the elderly with ST segment elevation myocardial infarction.

OBJECTIVE: Primary percutaneous coronary intervention (P-PCI) has demonstrated its efficacy in patients with ST segment elevation myocardial infarction (STEMI). However, patients with STEMI ≥75 years receive less P-PCI than younger patients despite their higher in-hospital morbimortality. The objective of this analysis was to determine the effectiveness of P-PCI in patients with STEMI ≥75 years. METHODS: We included 979 patients with STEMI ≥75 years, from the ATención HOspitalaria del Síndrome coronario study, a registry of 8142 consecutive patients with acute coronary syndrome admitted at 31 Spanish hospitals in 2014-2016. We calculated a propensity score (PS) for the indication of P-PCI. Patients that received or not P-PCI were matched by PS. Using logistic regression, we compared the effectiveness of performing P-PCI versus non-performance for the composite primary event, which included death, reinfarction, acute pulmonary oedema or cardiogenic shock during hospitalisation. RESULTS: Of the included patients, 81.5 % received P-PCI. The matching provided two groups of 169 patients with and without P-PCI. Compared with its non-performance, P-PCI presented a composite event OR adjusted by PS of 0.55 (95% CI 0.34 to 0.89). CONCLUSIONS: Receiving a P-PCI was significantly associated with a reduced risk of major intrahospital complications in patients with STEMI aged 75 years or older.

Modelo de intervención coronaria percutánea primaria en las Islas Baleares / The primary percutaneous coronary intervention program in the Balearic Islands

Uno de los objetivos críticos de la estrategia de salud en la cardiopatía isquémica es la atención urgente del infarto agudo de miocardio con elevación del ST (IAMCEST) y más concretamente del síndrome coronario agudo con elevación del ST, en los que el tiempo asistencial es crítico. Esta inmediatez del tratamiento (ya sea mecánica o farmacológica) se debería reflejar en los resultados de morbimortalidad. En 2003, tras la evidencia científica de la necesidad de una revascularización mecánica (intervención coronaria percutánea primaria) en el infarto agudo de miocardio con elevación del segmento ST, se estableció esta opción terapéutica en el hospital de referencia de nuestra comunidad (programa de intervención coronaria percutánea primaria). En marzo de 2008, tras múltiples reuniones con diferentes estamentos y centros, se puso en marcha el Registro Comunitario de la Asistencia al Síndrome Coronario Agudo con Elevación del ST (Registro Código Infarto de las Illes Balears). Se realiza: a) detección y documentación de todos los casos diagnosticados de IAMCEST en la comunidad autónoma; b) evaluación sistemática de los resultados asistenciales del IAMCEST y su ajuste a los objetivos asistenciales (tiempos, morbimortalidad, complicaciones, tratamientos, etc.); c) identificación y abordaje de las desviaciones respecto a los objetivos; d) conocimiento exhaustivo e implicación en el proyecto de todos los dispositivos asistenciales, y e) seguimiento al mes, a los 6 meses y al año del alta hospitalaria tras el proceso agudo del IAMCEST (AU)

One of the main objectives of any health-care strategy for ischemic heart disease is to provide emergency treatment for acute myocardial infarction and especially for ST-elevation acute coronary syndrome (STEACS), where any delay in treatment is crucial. The speed with which treatment (whether mechanical or pharmacologic) can be implemented will be reflected in morbidity and mortality rates. In 2003, in response to scientific evidence that mechanical revascularization (i.e. primary percutaneous coronary intervention) is essential for ST-elevation acute myocardial infarction, this therapeutic technique was introduced at the referral hospital in our region (in a primary percutaneous coronary intervention program). In March 2008, after several meetings between various stakeholders and institutions, a regional trial of treatment for STEACS (i.e. the Balearic Islands myocardial infarction code trial) started. It involved: a) the identification and reporting of all patients diagnosed with STEACS in the region; b) a systematic analysis of the results of treatment for STEACS in comparison with treatment goals (e.g. treatment times, morbidity, mortality, complications and treatment provided); c) identifying and responding to any deviations from targets; d) thorough understanding of and involvement in the project by all parts of the health-care system, and e) follow-up 1 month, 6 months and 1 year after hospital discharge following the STEACS episode (AU)

Short-term (28 days) prognosis between genders according to the type of coronary event (Q-wave versus non-Q-wave acute myocardial infarction versus unstable angina pectoris).

The type of acute coronary syndrome may account for different prognoses between men and women after myocardial infarction. This study assessed gender differences in 28-day mortality rates for first or recurrent Q-wave and non-Q-wave myocardial infarctions and unstable angina by using data from 5 registries that included 20,836 patients (24.8% women). Mortality rates were higher in women with first Q-wave myocardial infarction but not in the other patients after adjusting for confounding variables.