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FAST-MI program highlights risk factors for STEMI
MUNICH — The overall mortality rate for patients hospitalized with STEMI in France decreased by 68% from 1995 to 2010, which was attributed to more use of reperfusion therapy and recommended measures following an MI, according to data from an analysis of four French nationwide registries.
Despite this decline, Nicolas Danchin, MD, and fellow researchers also reported an increase in the proportion of STEMI among women aged younger than 60 years.
Researchers for the FAST-MI program analyzed data from four 1-month French nationwide registries conducted 5 years apart: USIK in 1995; USIC in 2000; FAST-MI in 2005; and FAST-MI in 2000. Overall, data on more than 6,700 STEMI patients admitted to intensive care or coronary care units were assessed.
During the 15-year study period, the mean age of patients with STEMI declined from 66.2 years to 63.3 years. Decreases were also observed in patients with a history of CVD, including MI, HF, peripheral artery disease, stroke or transient ischemic attack.
The proportion of women aged 60 years or younger with STEMI more than doubled from 11.8% to 25.5%, and the proportion of women aged 50 years or younger with STEMI tripled from 3.7% to 11.1%, Danchin, of Hôpital Européen Georges Pompidou, Paris, said at a press conference. Among women, these increases were consistent with the increased prevalence of smoking (37.3% in 1995 to 73.1% in 2010) and obesity (17.6% in 1995 to 27.1% in 2010), he said. In men, the prevalence of smoking did not significantly change and there was an increase in obesity, but to a lesser extent than women, in all age classes during the study period.
“The important message, in my mind, is that everyone should be aware that younger women are now at risk for developing a MI. There is a very strong link with smoking and obesity,” Danchin said.
Additionally, use of reperfusion therapy increased from 49.4% to 74.7%, with more frequent use of primary PCI (11.9% to 60.8%).
Other results from the 15-year analysis include:
- A gradual increase in the use of evidence-based treatments (statins, beta-blockers, ACE inhibitors, angiotensin receptor blockers) during the first 48 hours of admission. Early use of antiplatelet agents and low-molecular-weight heparins also increased.
- A decrease in crude 30-day mortality (13.7% to 4.4%) and standardized mortality (11.3% to 4.4%).
- Less frequent major hospital complications of STEMI.
- Shortened time from symptom onset to hospital admission, with shorter time from onset to call for medical help (120 minutes in 2000 to 74 minutes in 2010). Use of mobile ICUs also increased.
“There have been important changes in patient behavior and medical management, both in terms of invasive strategies and medications used at an early stage,” Danchin said at the Hot Line trial session. “We feel that future efforts should now be directed at increasing the awareness of health authorities, health care professionals and the public to the growing proportion of younger women among STEMI patients.” – by Katie Kalvaitis
For more information:
Danchin N. Hot line II: Late breaking trials on interventions. Presented at: the European Society of Cardiology Congress; Aug. 25-29, 2012; Munich.
Puymirat E. JAMA. 2012;doi:10.1001/2012.jama.11348.
Disclosure: Dr. Durchin reports receiving research grants from AstraZeneca, Daiichi Sankyo, Eli Lilly, GlaxoSmithKline, MSD, Novartis, Pfizer, Sanofi-Aventis, Servier and The Medicines Company; he also reports advisory panels or lecture fees from AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly, Menarini, Merck-Serono, Novo Nordisk, Servier and Sanofi-Aventis.