ST-Elevation Acute Myocardial Infarction in Australia—Temporal Trends in Patient Management and Outcomes 1999–2016

Article


Aliprandi-Costa, Bernadette, Morgan, Lucy, Snell, Lan Chi, Souza, Mario D., Kritharides, Leonard, French, John, Brieger, David and Ranasinghe, Isuru. 2019. "ST-Elevation Acute Myocardial Infarction in Australia—Temporal Trends in Patient Management and Outcomes 1999–2016." Heart Lung and Circulation. 28 (7), pp. 1000-1008. https://doi.org/10.1016/j.hlc.2018.05.191
Article Title

ST-Elevation Acute Myocardial Infarction in Australia—Temporal Trends in Patient Management and Outcomes 1999–2016

ERA Journal ID16185
Article CategoryArticle
AuthorsAliprandi-Costa, Bernadette (Author), Morgan, Lucy (Author), Snell, Lan Chi (Author), Souza, Mario D. (Author), Kritharides, Leonard (Author), French, John (Author), Brieger, David (Author) and Ranasinghe, Isuru (Author)
Journal TitleHeart Lung and Circulation
Journal Citation28 (7), pp. 1000-1008
Number of Pages9
Year2019
Place of PublicationAustralia
ISSN1443-9506
1444-2892
Digital Object Identifier (DOI)https://doi.org/10.1016/j.hlc.2018.05.191
Web Address (URL)https://www.heartlungcirc.org/article/S1443-9506(18)30697-8/fulltext
Abstract

Background: Increased access to reperfusion for ST elevation myocardial infarction (STEMI) has contributed to reduced mortality internationally. We describe temporal trends in pre-hospital care, in-hospital management and outcomes of the STEMI population in Australia. Methods: Temporal trends with multiple regression analysis on the management and outcomes of STEMI patients enrolled across 46 Australian hospitals in the Australian cohort of the Global Registry of Acute Coronary Events (GRACE) and the Cooperative National Registry of Acute Coronary Care Guideline Adherence and Clinical Events (CONCORDANCE) between February 1999 and August 2016. Results: 4,110 patients were treated for STEMI, mean age 62.5 ± 13.7years (SD). The median door-to-balloon time of primary percutaneous coronary intervention (PPCI) decreased by 11 minutes (p < 0.01) although there was no increase in rates of PPCI (p = 0.35). Access to non-primary PCI increased by 39% (p < 0.01), provisioning of fibrinolysis decreased by 13% (p < 0.01) and the median door-to-needle time of 35 minutes remained unchanged (p = 0.09). Prescription of medical therapies in-hospital remained high, and at discharge there was an increase in prescription of statins (p < 0.01); aspirin including antiplatelets (p < 0.01), beta blockers (p = 0.023) and ACE/ARB (p = 0.02). The occurrence of any in-hospital adverse clinical events declined by 78% (p < 0.01) albeit, there was no reduction in mortality in-hospital (p = 0.84) or within 6 months (p = 0.81). Conclusions: Over time, there has been increased access to non-primary PCI; shorter door-to-balloon times for PPCI; less adverse events in-hospital and fewer readmissions for unplanned revascularisation without the realisation of reduced mortality in-hospital or at 6 months.

KeywordsAcute coronary syndromes; ST-elevation myocardial infarction; Quality outcomes; Clinical registry
ANZSRC Field of Research 2020350611. Service marketing
Institution of OriginUniversity of Southern Queensland
Byline AffiliationsUniversity of Sydney
University of Technology Sydney
Department of Health, New South Wales
Department of Health, South Australia
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