From 2005 to 2019, 1-year all-cause mortality after AMI decreased by 8.6%, mainly driven by pharmacology (27.75% contribution) and PCI (17.63% contribution).
What are the temporal trends and determinants of 1-year mortality in patients with acute myocardial infarction between 2005 and 2019?
Advances in medical therapy and increased use of PCI have significantly driven an 8.6% absolute reduction in 1-year all-cause mortality after acute myocardial infarction over a 15-year period.
Absolute Event Rate: 0% vs 0%
Abstract Background Acute myocardial infarction (AMI) is a leading cause of mortality and morbidity worldwide. Several past studies only explored temporal trends in both short-term and long-term mortality, but did not quantify the contributors of the changes. Therefore, there is limited information on determinants of changes in long-term mortality, following AMI. Purpose To investigate the temporal trends in 1-year mortality after AMI, and identify the factors that influence changes in mortality over time. Methods The study included 852,914 patients aged 18-100 years and admitted with AMI from the Myocardial Ischaemia National Audit Project (MINAP) database linked with the Office for National Statistics (ONS) mortality registry in England and Wales, between 2005-2019. The primary outcome was all-cause 1-year mortality from admission date. There were two secondary outcomes: 1-year all-cause mortality from discharge date and 1-year cardiovascular mortality from admission date. Additionally, the study conducted subgroup analyses of the primary outcome for patients with ST-elevated myocardial infarction (STEMI) and those with non-ST-elevated myocardial infarction (NSTEMI) separately. Fairlie decomposition method was used to quantify the contributions of various factors to 1-year all-cause and cardiovascular mortality changes over time. Results There was an 8.6% reduction in observed 1-year all-cause mortality from 22.8% (95% CI: 22.4%, 23.2%) in 2005 to 14.2% (95% CI: 13.7%, 14.7%) in 2019. Of this difference, 68.2% was explained by the variables included in our model. The "pharmacology" domain (statin, angiotensin-converting enzyme inhibitors/ angiotensin II receptor blocker, beta blockers, nitrates, calcium channel blockers) contributed the most to the reduction in 1-year mortality over time, with a relative contribution (RC) of 27.75% (95% CI: 26.04%, 29.46%, p0.001), followed by any percutaneous coronary intervention (PCI) during hospitalization (RC:17.63%, 95% CI: 16.27%, 18.99%, p 0.001). Similarly, 1-year cardiovascular mortality reduced from 16.8% in 2005 to 9.2% in 2019 with "pharmacology" domain contributing the most to this reduction (RC:25.39%, 95%CI:23.57%,27.21%). However, after discharge, PCI contributed the most to the reduction in all-cause mortality (RC:27.36%, 95%CI:24.69%,30.03%). For STEMI patients only, "pharmacology" domain remained the highest contributor to the reduction in all-cause mortality (RC:46.01%, 95%CI:41.26%,50.76%), while for NSTEMI patients, PCI contributed the most to the reduction in all-cause mortality (RC:22.78%, 95%CI:20.67%,24.88%). Conclusions This study demonstrates significant reductions in 1-year all-cause and cardiovascular mortality over 15 years, largely driven by advances in medical therapy and PCI. This has significant implications for clinical practice and future research that should explore the unexplained drivers of the changes in mortality.
Ayayo et al. (Sat,) reported a other. From 2005 to 2019, 1-year all-cause mortality after AMI decreased by 8.6%, mainly driven by pharmacology (27.75% contribution) and PCI (17.63% contribution).