More MI Treatments Tied to Decreased Mortality in Sweden

Patients with STEMI have reduced mortality linked to increased use of evidence-based treatments

TUESDAY, April 26 (HealthDay News) -- For patients with ST-elevation myocardial infarction (STEMI) in Sweden, an increase in evidence-based treatments is associated with a decrease in 30-day and one-year mortality, according to a study published in the April 27 issue of the Journal of the American Medical Association.

Tomas Jernberg, M.D., Ph.D., from the Karolinska University Hospital in Stockholm, Sweden, and colleagues evaluated the short- and long-term survival in 61,238 patients with a first-time diagnosis of STEMI between 1996 and 2007 in Sweden. The proportion of patients treated with different medications and procedures as well as mortality were measured over time.

The investigators found that there were significant increases in evidence-based treatments: reperfusion (66 to 79 percent), primary percutaneous coronary intervention (12 to 61 percent), and revascularization (10 to 84 percent). The use of statins, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, and clopidogrel all increased significantly, and the use of aspirin and β-blockers also increased. There were significant decreases in the estimated in-hospital, 30-day mortality, and one-year mortality (from 12.5 to 7.2 percent, 15.0 to 8.6 percent, and 21.0 to 13.3 percent, respectively). After adjustment, there was still a trend of lower mortality. A 12-year survival analysis showed that reduction in mortality was sustained over time.

"Implementation of new treatment strategies over 12 years in STEMI patients in Sweden [was] associated with an increased use of evidence-based treatments, better adherence to treatment guidelines, and reduced variation across hospitals. These gradual changes in practice were associated with a large and sustained reduction in mortality," the authors write.

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