The temporal trends of ST-elevation myocardial infarction mortality according to infarct size and location: insights from the UK National MINAP registry from 2005 to 2019.

European heart journal open Pub Date : 2025-08-20 eCollection Date: 2025-09-01 DOI:10.1093/ehjopen/oeaf111
Nicholas Weight, Rodrigo Bagur, Nicholas Chew, Sripal Bangalore, Purvi Parwani, Louise Y Sun, Yu Chen Wang, Muhammad Rashid, Mamas A Mamas
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Abstract

Aims: Myocardial infarction size is associated with mortality in ST-elevation myocardial infarction (STEMI). With advances in primary percutaneous coronary intervention (PPCI) and medical therapy, whether this relationship has changed over time is unclear.

Methods and results: Patients with STEMI in the UK from 2005 to 2019 were included from the national AMI MINAP registry, with mortality linkage to 2021. Primary outcomes were all-cause mortality at 30 days and 1 year according to infarct size, using Cox regression models. Infarct size was stratified by Tertiles (T1-3) of peak troponin level (T1, smallest; T3, largest), across the early (2005-09), middle (2010-14), and late (2015-19) periods. Subgroup analyses assessed the relationship according to infarct location (anterior vs. non-anterior). A total of 177 214 STEMI patients were included. Adjusted 30-day mortality risk according to infarct size was highest in the early period (aHR: 1.32, 1.21-1.45, P < 0.001), compared to middle (1.12, 1.04-1.20, P = 0.002) and late study periods (1.05, 0.96-1.14, P = 0.299). The relationship between infarct size and 30-day mortality was significant for patients with anterior STEMI in early (1.39, 1.22-1.57, P < 0.001) but not middle or late periods, while remained significant for non-anterior infarction until the late period (early, 1.28, 1.13-1.45, P < 0.001; middle, 1.17, 1.06-1.29, P = 0.002; late, 1.09, 0.96-1.24, P = 0.180).

Conclusion: We observed an independent relationship between infarct size and STEMI mortality, strongest between 2005 and 2009, which reduced over time, becoming non-significant in the 2015-19 period. This association diminished more rapidly for patients with anterior STEMIs. These findings underscore the potential role of contemporary revascularization, systems of care, and guideline-directed medical therapy in reducing STEMI-related mortality.

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根据梗死面积和位置,st段抬高型心肌梗死死亡率的时间趋势:来自2005年至2019年英国国家MINAP登记的见解
目的:心肌梗死大小与st段抬高型心肌梗死(STEMI)的死亡率相关。随着初级经皮冠状动脉介入治疗(PPCI)和药物治疗的进展,这种关系是否随着时间的推移而改变尚不清楚。方法和结果:2005年至2019年英国STEMI患者纳入了全国AMI MINAP注册表,死亡率与2021年相关。根据梗死面积,采用Cox回归模型,主要结局是30天和1年的全因死亡率。梗死面积按肌钙蛋白峰值水平(T1,最小;T3,最大)的梯位(T1-3)在早期(2005-09)、中期(2010-14)和晚期(2015-19)分层。亚组分析根据梗死位置(前路vs非前路)评估两者之间的关系。共纳入177214例STEMI患者。与研究中期(1.12,1.04-1.20,P = 0.002)和研究后期(1.05,0.96-1.14,P = 0.299)相比,早期(aHR: 1.32, 1.21-1.45, P < 0.001)调整后的30天死亡风险最高。前路STEMI患者梗死面积与30天死亡率的关系在早期(1.39,1.22-1.57,P < 0.001)显著,中晚期不显著,而非前路梗死直至晚期仍显著(早期,1.28,1.13-1.45,P < 0.001;中期,1.17,1.06-1.29,P = 0.002;晚期,1.09,0.96-1.24,P = 0.180)。结论:我们观察到梗死面积与STEMI死亡率之间的独立关系,在2005年至2009年期间最强,随着时间的推移而降低,在2015年至2019年期间变得不显著。这种相关性在前路stemi患者中消失得更快。这些发现强调了当代血运重建术、护理系统和指导医学治疗在降低stemi相关死亡率方面的潜在作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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