The Persistent Mortality and Heart Failure Burden of Anterior ST-Segment Elevation Myocardial Infarction Following Primary Percutaneous Coronary Intervention

BackgroundThere is limited data on temporal trends in clinical outcomes after ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) particularly beyond one year and in real world populations that include patients often excluded from randomized trials. ObjectivesWe sought to compare the temporal trends in the incidence of death and re-hospitalization for congestive heart failure (CHF) following anterior STEMI in a Medicare cohort of beneficiaries treated with primary PCI in 2005 (n = 1,479) with those treated in 2016 through quarter (Q) 2 of 2017 (n = 22,432). MethodsOutcomes were examined using both descriptive and regression analysis to control for differences in patient clinical characteristics over time. ResultsThe 1-year mortality rate trended higher in the late cohort (10.3 vs 8.9%, p=0.068). The 2-year mortality rate was significantly higher in the late cohort (14.5 vs 11.4%, p<0.01). The one-year re-hospitalization for CHF was lower in the late cohort (10.6 versus 16.7%, p<0.01), but the 2-year rate was unchanged (19.3 vs 20.7%, p=0.55). After adjustment for covariates with two models there were highly statistically significant increases in mortality at 1-year (2.3 - 4.1%) and 2-years (4.2 - 6.5%) in the late cohort. The unadjusted trends in re-hospitalization for CHF persisted after adjustment for covariates. ConclusionsDespite prior improvements in STEMI outcomes in the reperfusion era related to the broad adoption of timely PCI, there is a persistent high mortality and CHF burden in patients with anterior STEMI. New strategies that address reperfusion injury and enhance myocardial salvage are needed.