5-year mortality after ST-segment elevation myocardial infarction compared to the general population

Abstract Background The long-term prognosis of early survivors of ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI) is well-established as comparable to that of the general population. However, outcomes for those managed with fibrinolysis or no reperfusion remain uncertain. Purpose This study aims to evaluate excess mortality in STEMI patients treated with PPCI, fibrinolysis, and no reperfusion, compared to an age- and sex-matched general population, across three key periods: 0 to 30 days, 31 to 90 days, and 91 days to 5 years. Methods We utilized the China Acute Myocardial Infarction (CAMI) registry to identify first MI cases from 2013 to 2014, with a follow-up period of 5 years. Age- and sex-matched comparators were selected from four long-term cohorts: the Prospective Urban Rural Epidemiology (PURE)-China, China Health and Retirement Longitudinal Study (CHARLS), the China Health and Nutrition Survey (CHNS), and the Chinese Longitudinal Healthy Longevity Survey (CLHLS), with each patient being matched to up to 5 comparators. Flexible parametric survival models were used to estimate the excess mortality risk. Results A total of 17,464 patients with first-time STEMI were matched with 58,259 comparators from the general population. Significant excess mortality was observed in STEMI patients during both the 0–30-day and 31–90-day periods across all three treatment strategies. Among 90-day survivors, the absolute excess mortality at 5 years was 2.63 percentage points (95% CI: 2.13-3.13; HR Hazard Ratio: 1.43; 95% CI: 1.34–1.53). Excess mortality persisted in patients treated with no reperfusion (4.20%, 95% CI: 3.29–5.08; HR: 1.55, 95% CI: 1.43–1.68) and fibrinolysis (2.60%, 95% CI: 1.43–3.81; HR: 1.51, 95% CI: 1.27–1.79). In contrast, 90-day STEMI survivors treated with PPCI showed no significant excess mortality, with an absolute difference of -0.41 percentage points at 5 years (95% CI: -1.04% – 0.21%) and a non-significant HR of 0.92(95% CI: 0.82–1.03). Conclusions PPCI provides significant long-term benefits for STEMI patients, with 5-year excess mortality comparable to that of the general population. In contrast, patients treated conservatively or with fibrinolytic therapy experience a worse long-term prognosis, highlighting the need to address issue of ineligible patients and maximize access to PPCI for eligible STEMI patients.5-Year Mortality After STEMI Flow-chart