TEN-YEAR TRENDS IN REVASCULARIZATION, IN-HOSPITAL TREATMENTS, AND OUTCOMES IN PATIENTS WITH STEMI.

Abstract

Background: Reports on the care of patients with ST-Elevation Acute Mycoardium Infarction (STEMI) from low- or middle-income settings are scarce. And trend analysis, from long-term studies, are even scarcer.

Objective: we sought to report changes in revascularization, in-hospital treatments, and outcomes of patients with STEMI admitted in the last ten years, included in the REgistro de Sindromes Coronarios AgUdos (RESCUE) database, from a middle-income scenario without coronary intervention Methods: The RESCUE database (2014 to December 2023) was queried to identify all STEMI hospitalizations. Temporal trends, outcomes, demographics, revascularization, in-hospital and discharge medications in these patients were determined. Also, overall defect-free care, a composite measure capturing use of guideline-directed medical therapy (GDMT) at admission and at discharge was reported.

Results: Among 1456 patients with STEMI, there was significant increase in fibrinolytic administration (58.2% in 2014-2016 vs 70.3% in 2021-2023, P≤0.01). Overall defect free care composite at admission and at discharge was only achieved in 37.4% and 74.3% of patients, respectively. Administration of Aspirin, Clopidogrel, statin, Angiotensin Converter Enzyme Inhibitor (ACEI), Beta-blocker (BB) was 98.6%, 98%, 98.1%, 92.4%, 61.7%. At discharge, it was 97.9%, 96.1%, and 95%, 96.7% and 80.7%. Unadjusted in-hospital mortality decreased from 2014-2016 to 2021-2023 (14-7.7%, P=0.012). However, risk-adjusted mortality rate increased significantly (5-8.9%, P<0.001).

Conclusion: There has been a steady improvement in process measures and a high adherence to GDMT in this population. In-hospital mortality has remained stable, despite not having defect-free care in most patients. The RESCUE registry continues to play an important role in improving healthcare delivery and patient outcomes in this location.