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

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Journal Article
Heart Lung and Circulation, 2019, 28 (7), pp. 1000 - 1008
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© 2018 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ) 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. Trial registration: CONCORDANCE Registry ACTRN: 12614000887673.
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