Determinants of improved one-year survival in non-ST-segment elevation myocardial infarction patients: Insights from the French FAST-MI program over 15 years

Abstract

BackgroundImproved early outcome in non-ST elevation myocardial infarction (NSTEMI) patients has been mainly attributed to a broader use of invasive strategies. Little is known about the impact of other changes in early management. MethodsWe aimed to assess 15-year trends in one-year mortality and their determinants in NSTEMI patients. We used data from 4 one-month French registries, conducted 5years apart from 1995 to 2010 including 3903 NSTEMI patients admitted to intensive care units. ResultsFrom 1995 to 2010, no major change was observed in patient characteristics, while therapeutic management evolved considerably. Early use of antiplatelet agents, β-blockers, ACE-inhibitors and statins increased over time (P<0.001); use of newer anticoagulants (low-molecular-weight heparin, bivalirudin or fondaparinux) increased from 40.8% in 2000 to 78.9% in 2010 (P<0.001); percutaneous coronary intervention (PCI)≤3days of admission rose from 7.6% to 48.1% (P<0.001). One-year death decreased from 20% to 9.8% (HR adjusted for baseline parameters, 2010 vs. 1995=0.47, 95% CI: 0.35–0.62). Early PCI (HR=0.67; 95% CI: 0.49–0.90), use of newer anticoagulants (HR=0.62; 95% CI: 0.48–0.78) and early use of evidence based medical therapy (HR=0.54; 95% CI: 0.40–0.72) were predictors of improved one year-survival. ConclusionsOne-year mortality of NSTEMI patients decreased by 50% in the past 15years. Our data support current guidelines recommending early invasive strategies and use of newer anticoagulants for NSTEMI, and also show a strong positive association between early use of appropriate medical therapies and one-year survival, suggesting that these medications should be used from the start.