Five-year outcome after STEMI in primary PCI era

Abstract

This review summarizes the information available from long-term follow-up after ST-elevation myocardial infarction (STEMI) in the primary percutaneous coronary intervention (p-PCI) era. The main aim of this review is to present an overview of long-term overall mortality, cardiac mortality, and major adverse cardiac events (MACE). We searched and analyzed trials with 5-year and longer follow-up periods published from January 2001 to December 2019. Only p-PCI trials were included. Overall mortality at 5-year follow-up was 9.3-23.3 % and annual overall mortality was around 2 % for the years following the first one after STEMI. Cardiac mortality at 5-year follow-up was 4.7-16.0 % and annual cardiac mortality was approximately 1.1-1.5 % for the years following the first one after STEMI. The cumulative incidences of reinfarction at 5-year follow-up, heart failure requiring admission, additional revascularization, and stroke were 5.0-18.0, 4.0-18.5 %, 19.0-37.1 %, and 2.6-8.0 %, respectively. The cumulative incidence of in-stent thrombosis was 2.6 %. The cumulative incidence of restenosis was 7.8 %. The results of the above-mentioned trials suggest a high proportion of cardiovascular deaths and MACE in the long-term follow-up period. With respect to these facts, questions arise as to how to reduce MACE and the possibility of routine use of coronary artery imaging in the follow-up.