Temporal Trends, Predictors, and Outcomes of Acute Ischemic Stroke in Acute Myocardial Infarction in the United States

Background There are limited contemporary data prevalence and outcomes of acute ischemic stroke (AIS) complicating acute myocardial infarction (AMI). Methods and Results Adult (>18 years) AMI admissions using the National Inpatient Sample database (2000–2017) were evaluated for in‐hospital AIS. Outcomes of interest included in‐hospital mortality, hospitalization costs, length of stay, discharge disposition, and use of tracheostomy and percutaneous endoscopic gastrostomy. The discharge destination was used to classify survivors into good and poor outcomes. Of a total 11 622 528 AMI admissions, 183 896 (1.6%) had concomitant AIS. As compared with 2000, in 2017, AIS rates increased slightly among ST‐segment–elevation AMI (adjusted odds ratio, 1.10 [95% CI, 1.04–1.15]) and decreased in non–ST‐segment–elevation AMI (adjusted odds ratio, 0.47 [95% CI, 0.46–0.49]) admissions ( P <0.001). Compared with those without, the AIS cohort was on average older, female, of non‐White race, with greater comorbidities, and higher rates of arrhythmias. The AMI‐AIS admissions received less frequent coronary angiography (46.9% versus 63.8%) and percutaneous coronary intervention (22.7% versus 41.8%) ( P <0.001). The AIS cohort had higher in‐hospital mortality (16.4% versus 6.0%; adjusted odds ratio, 1.75 [95% CI, 1.72–1.78]; P <0.001), longer hospital length of stay, higher hospitalization costs, greater use of tracheostomy and percutaneous endoscopic gastrostomy, and less frequent discharges to home (all P <0.001). Among AMI‐AIS survivors (N=153 318), 57.3% had a poor functional outcome at discharge with relatively stable temporal trends. Conclusions AIS is associated with significantly higher in‐hospital mortality and poor functional outcomes in AMI admissions.

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Temporal Trends, Clinical Characteristics and Outcomes of Emergent Coronary Artery Bypass Grafting for Acute Myocardial Infarction in the United States

Journal of the American Heart Association ◽

10.1161/jaha.120.020517 ◽

2021 ◽

Author(s):

Sri Harsha Patlolla ◽

Ardaas Kanwar ◽

Wisit Cheungpasitporn ◽

Rajkumar P Doshi ◽

John M Stulak ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Coronary Artery ◽

Hospital Mortality ◽

Artery Bypass ◽

Temporal Trends ◽

Bypass Grafting ◽

St Segment Elevation ◽

St Segment ◽

Hospitalization Costs

Abstract Background There are limited contemporary data on the use of emergent coronary artery bypass grafting (CABG) in acute myocardial infarction (AMI). Methods and Results Adult (>18 years) AMI admissions were identified using the National Inpatient Sample (2000‐2017) and classified by tertiles of admission year. Outcomes of interest included temporal trends of CABG use, age‐, sex‐, and race‐stratified trends in CABG use, in‐hospital mortality, hospitalization costs, and hospital length of stay. Of the 11,622,528 AMI admissions, emergent CABG was performed in 1,071,156 (9.2%). CABG utilization decreased overall (10.5% [2000] to 8.7% [2017]; adjusted odds ratio [OR] 0.98 [95% confidence interval {CI} 0.98‐0.98]; p<0.001), in ST‐segment‐elevation AMI (STEMI) (10.2% [2000] to 5.2% [2017]; adjusted OR 0.95 [95% CI 0.95‐0.95]; p<0.001) and non‐ST‐segment‐elevation AMI (NSTEMI) (10.8% [2000] to 10.0% [2017]; adjusted OR 0.99 [95% CI 0.99‐0.99]; p<0.001), with consistent age, sex and race trends. In 2012‐2017, compared to 2000‐2005, admissions receiving emergent CABG were more likely to have NSTEMI (80.5% vs. 56.1%), higher rates of non‐cardiac multiorgan failure (26.1% vs. 8.4%), cardiogenic shock (11.5% vs. 6.4%) and use of mechanical circulatory support (19.8% vs. 18.7%). In‐hospital mortality in CABG admissions decreased from 5.3% [2000] to 3.6% [2017]; adjusted OR 0.89 [95% CI 0.88‐0.89]; p<0.001 in the overall cohort, with similar temporal trends in STEMI and NSTEMI. An increase in lengths of hospital stay and hospitalization costs was seen over time. Conclusions Utilization of CABG has decreased substantially in AMI admissions, especially in STEMI. Despite an increase in acuity and multi‐organ failure, in‐hospital mortality consistently decreased this population.

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Impact of Coronavirus Disease 2019 Pandemic on the Incidence and Management of Out‐of‐Hospital Cardiac Arrest in Patients Presenting With Acute Myocardial Infarction in England

Journal of the American Heart Association ◽

10.1161/jaha.120.018379 ◽

2020 ◽

Vol 9 (22) ◽

Author(s):

Muhammad Rashid (Hons) ◽

Chris P. Gale (Hons) ◽

Nick Curzen (Hons) ◽

Peter Ludman (Hons) ◽

Mark De Belder (Hons) ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cardiac Arrest ◽

Hospital Mortality ◽

Invasive Coronary Angiography ◽

Temporal Trends ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Hospital Cardiac Arrest

Background Studies have reported significant reduction in acute myocardial infarction–related hospitalizations during the coronavirus disease 2019 (COVID‐19) pandemic. However, whether these trends are associated with increased incidence of out‐of‐hospital cardiac arrest (OHCA) in this population is unknown. Methods and Results Acute myocardial infarction hospitalizations with OHCA during the COVID‐19 period (February 1–May 14, 2020) from the Myocardial Ischaemia National Audit Project and British Cardiovascular Intervention Society data sets were analyzed. Temporal trends were assessed using Poisson models with equivalent pre–COVID‐19 period (February 1–May 14, 2019) as reference. Acute myocardial infarction hospitalizations during COVID‐19 period were reduced by >50% (n=20 310 versus n=9325). OHCA was more prevalent during the COVID‐19 period compared with the pre–COVID‐19 period (5.6% versus 3.6%), with a 56% increase in the incidence of OHCA (incidence rate ratio, 1.56; 95% CI, 1.39–1.74). Patients experiencing OHCA during COVID‐19 period were likely to be older, likely to be women, likely to be of Asian ethnicity, and more likely to present with ST‐segment–elevation myocardial infarction. The overall rates of invasive coronary angiography (58.4% versus 71.6%; P <0.001) were significantly lower among the OHCA group during COVID‐19 period with increased time to reperfusion (mean, 2.1 versus 1.1 hours; P =0.05) in those with ST‐segment–elevation myocardial infarction. The adjusted in‐hospital mortality probability increased from 27.7% in February 2020 to 35.8% in May 2020 in the COVID‐19 group ( P <.001). Conclusions In this national cohort of hospitalized patients with acute myocardial infarction, we observed a significant increase in incidence of OHCA during COVID‐19 period paralleled with reduced access to guideline‐recommended care and increased in‐hospital mortality.

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Same-Day Versus Non-Simultaneous Extracorporeal Membrane Oxygenation Support for In-Hospital Cardiac Arrest Complicating Acute Myocardial Infarction

Journal of Clinical Medicine ◽

10.3390/jcm9082613 ◽

2020 ◽

Vol 9 (8) ◽

pp. 2613

Author(s):

Saraschandra Vallabhajosyula ◽

Sri Harsha Patlolla ◽

Malcolm R. Bell ◽

Wisit Cheungpasitporn ◽

John M. Stulak ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cardiac Arrest ◽

Extracorporeal Membrane Oxygenation ◽

Hospital Mortality ◽

Ecmo Support ◽

St Segment Elevation ◽

St Segment ◽

Hospitalization Costs ◽

Hospital Cardiac Arrest

Background: Although extracorporeal membrane oxygenation (ECMO) is used for hemodynamic support for in-hospital cardiac arrest (IHCA) complicating acute myocardial infarction (AMI), there are limited data on the outcomes stratified by the timing of initiation of this strategy. Methods: Adult (>18 years) AMI admissions with IHCA were identified using the National Inpatient Sample (2000–2017) and the timing of ECMO with relation to IHCA was identified. Same-day vs. non-simultaneous ECMO support for IHCA were compared. Outcomes of interest included in-hospital mortality, temporal trends, hospitalization costs, and length of stay. Results: Of the 11.6 million AMI admissions, IHCA was noted in 1.5% with 914 (<0.01%) receiving ECMO support. The cohort receiving same-day ECMO (N = 795) was on average female, with lower comorbidity, higher rates of ST-segment-elevation AMI, shockable rhythm, and higher rates of complications. Compared to non-simultaneous ECMO, the same-day ECMO cohort had higher rates of coronary angiography (67.5% vs. 51.3%; p = 0.001) and comparable rates of percutaneous coronary intervention (58.9% vs. 63.9%; p = 0.32). The same-day ECMO cohort had higher in-hospital mortality (63.1% vs. 44.5%; adjusted odds ratio 3.98 (95% confidence interval 2.34–6.77); p < 0.001), shorter length of stay, and lower hospitalization costs. Older age, minority race, non-ST-segment elevation AMI, multiorgan failure, and complications independently predicted higher in-hospital mortality in IHCA complicating AMI. Conclusions: Same-day ECMO support for IHCA was associated with higher in-hospital mortality compared to those receiving non-simultaneous ECMO support. Though ECMO-assisted CPR is being increasingly used, careful candidate selection is key to improving outcomes in this population.

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Abstract 15100: Influence of Human Immunodeficiency Virus Infection on the Management and Outcomes of Acute Myocardial Infarction With Cardiogenic Shock

Circulation ◽

10.1161/circ.142.suppl_3.15100 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Vaibhav Jain ◽

Anna Subramaniam ◽

Saraschandra Vallabhajosyula

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Human Immunodeficiency Virus ◽

Coronary Angiography ◽

Hospital Mortality ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Hiv And Aids ◽

Hospitalization Costs ◽

Immunodeficiency Virus

Introduction: Cardiovascular disease risks are significantly higher in patients with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS). There are limited data on the management and outcomes of acute myocardial infarction-cardiogenic shock (AMI-CS) in patients with HIV/AIDS> Methods: A retrospective cohort of AMI-CS during 2000-2017 from the National Inpatient Sample was evaluated for concomitant HIV and AIDS. Outcomes of interest included in-hospital mortality, use of cardiac procedures, hospital length of stay, hospitalization costs, use of do-not-resuscitate (DNR) status, and palliative care use. A sub-group analysis was performed for those with and without AIDS within the HIV cohort. Results: A total 557,974 AMI-CS admissions were included, with HIV and AIDS in 1,321 (0.2%) and 985 (0.2%), respectively. The HIV cohort was younger (54.1 vs. 69.0 years), more often male, of non-white race, uninsured, from a lower socioeconomic status, and with higher comorbidity (all p <0.001). The HIV cohort had comparable multiorgan failure (37.8% vs. 39.0%) and cardiac arrest (28.7% vs. 27.4%) ( p >0.05). The cohorts with and without HIV had comparable rates of coronary angiography (70.2% vs. 69.0%; p =0.37), but less frequent early coronary angiography (hospital day zero) (39.1% vs. 42.5%; p <0.001). The cohort with HIV had comparable in-hospital mortality compared to those without (26.9% vs. 37.4%; adjusted odds ratio 1.04 [95% confidence interval 0.90-1.21]; p =0.61). The cohort with HIV had longer duration of hospitalization (10.8±10.1 vs 9.9±11.4 days), higher hospitalization costs (158±155 vs. 143±182 x1000 USD) and was discharged home (48.6% vs 41.8%) more often as compared to those without HIV (all p <0.005). In the HIV cohort, AIDS was associated with higher in-hospital mortality (28.8% vs. 21.1%; adjusted odds ratio 4.12 [95% confidence interval 1.89-9.00]; p <0.001). Secondary outcomes were relatively comparable between those with and without AIDS. Conclusions: The cohort with HIV had longer hospital stay and higher hospitalization costs; however these were comparable between those with and without AIDS.

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Intracranial Hemorrhage Complicating Acute Myocardial Infarction: An 18-Year National Study of Temporal Trends, Predictors, and Outcomes

Journal of Clinical Medicine ◽

10.3390/jcm9092717 ◽

2020 ◽

Vol 9 (9) ◽

pp. 2717

Author(s):

Sri Harsha Patlolla ◽

Pranathi R. Sundaragiri ◽

Wisit Cheungpasitporn ◽

Rajkumar Doshi ◽

Gregory W. Barsness ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Length Of Stay ◽

Hospital Mortality ◽

Intracranial Hemorrhage ◽

Percutaneous Endoscopic Gastrostomy ◽

Temporal Trends ◽

White Race ◽

Endoscopic Gastrostomy ◽

Hospitalization Costs

Background: There is a paucity of contemporary data on the burden of intracranial hemorrhage (ICH) complicating acute myocardial infarction (AMI). This study sought to evaluate the temporal trends, predictors, and outcomes of ICH in AMI. Methods: The National Inpatient Sample (2000–2017) was used to identify adult (>18 years) AMI admissions with ICH. In-hospital mortality, hospitalization costs, length of stay, and measure of functional ability were the outcomes of interest. The discharge destination along with use of tracheostomy and percutaneous endoscopic gastrostomy were used to estimate functional burden. Results: Of a total 11,622,528 AMI admissions, 23,422 (0.2%) had concomitant ICH. Compared to those without, the ICH cohort was on average older, female, of non-White race, had greater comorbidities, and had higher rates of arrhythmias (all p < 0.001). Female sex, non-White race, ST-segment elevation AMI presentation, use of fibrinolytics, mechanical circulatory support, and invasive mechanical ventilation were identified as individual predictors of ICH. The AMI admissions with ICH received less frequent coronary angiography (46.9% vs. 63.8%), percutaneous coronary intervention (22.7% vs. 41.8%), and coronary artery bypass grafting (5.4% vs. 9.2%), as compared to those without (p < 0.001). ICH was associated with a significantly higher in-hospital mortality (41.4% vs. 6.1%; adjusted OR 5.65 (95% CI 5.47–5.84); p < 0.001), longer hospital length of stay, higher hospitalization costs, and greater use of percutaneous endoscopic gastrostomy (all p < 0.001). Among ICH survivors (N = 13, 689), 81.3% had a poor functional outcome at discharge. Conclusions: ICH causes a substantial burden in AMI due to associated higher in-hospital mortality and poor functional outcomes.

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P5502Comparison of clinical characteristics and prognosis between non-octogenarians and octogenarians with cardiac troponin positive acute myocardial infarction

European Heart Journal ◽

10.1093/eurheartj/ehz746.0452 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

T Soeda ◽

M Ishihara ◽

F Fujino ◽

H Ogawa ◽

K Nakao ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Hospital Mortality ◽

Cardiac Troponin ◽

Clinical Characteristics ◽

St Segment Elevation ◽

The Poor ◽

St Segment ◽

Universal Definition ◽

Multicenter Registry

Abstract Background Cardiac troponin (cTn) is the preferred biomarker for the diagnosis of acute myocardial infarction (AMI). Octogenarians who presented cTn positive AMI are not usually recruited in clinical trials. Therefore, their clinical characteristics and prognosis are rarely investigated. Objective To study the characteristics and prognosis in octogenarians who presented cTn positive AMI. Methods and results The Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET) is a prospective and multicenter registry. A total of 3,283 consecutive AMI patients who were diagnosed by cTn-based criteria were included. The patients were divided into non-octogenarians (n=2,593) and octogenarians (n=690). Compared with non- octogenarians, octogenarians showed significantly lower incidence of diabetes mellitus (37.6% and 31.9%, p=0.006) and dyslipidemia (53.6% and 45.6%, p<0.001), and significantly higher incidence of hypertension (64.1% and 75.3%, p<0.001) and chronic kidney disease (38.7% and 68.7%, p<0.001). Octogenarians showed significantly longer onset to door time (p<0.001) and longer door to device time (p<0.001). Though, compared with non-octogenarians, octogenarians showed lower peak CK (2,506 and 1,926, p<0.001), LVEF was significantly lower in octogenarians (54.6% and 52.6%, p=0.005). The presentation of AMI was different between the two group. The incidence of ST-segment elevation MI (STEMI) was 70.7% in non-octogenarians and 62.0% in octogenarians. Non-STEMI with CK elevation and without CK elevation were 16.2% and 13.1% in non- octogenarians, and 20.9% and 17.1% in octogenarians. In-hospital mortality was higher in octogenarians (4.7% and 13.2%, P<0.001). Especially, octogenarians with STEMI and non-STEMI with CK elevation showed the highest in-hospital mortality. And octogenarians without CK elevation showed similar in hospital mortality with non-octogenarians with STEMI (Figure). Conclusions J-MINUET showed the poor prognosis of octogenarians who were diagnosed as AMI based on cTn. Acknowledgement/Funding None

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Abstract 14759: Burden of Intracranial Hemorrhage in Patients With Acute Myocardial Infarction in the United States, 2000-2017

Circulation ◽

10.1161/circ.142.suppl_3.14759 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Sri Harsha Patlolla ◽

Saraschandra Vallabhajosyula

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Length Of Stay ◽

Hospital Mortality ◽

Intracranial Hemorrhage ◽

Temporal Trends ◽

The United States ◽

Circulatory Support ◽

White Race ◽

Hospitalization Costs

Introduction: There is a paucity of contemporary data on the burden of intracranial hemorrhage (ICH) complicating acute myocardial infarction (AMI). Methods: The National Inpatient Sample database (2000 to 2017) was used to evaluate in-hospital burden of ICH in adult (>18 years) AMI admissions. In-hospital mortality, hospitalization costs, length of stay, and measure of functional ability were the outcomes of interest. The discharge destination along with use of tracheostomy and percutaneous endoscopic gastrostomy (PEG) were used to estimate functional burden. Results: Of a total 11,622,528 AMI admissions, 23,422 (0.2%) had concomitant ICH. Compared to those without, admissions with ICH were on average older, female, of non-White race, with greater comorbidities, and higher rates of arrhythmias (all p<0.001). Female sex, non-White race, ST-segment-elevation AMI presentation, use of fibrinolytics, mechanical circulatory support and invasive mechanical ventilation were identified as individual predictors of ICH. The AMI admissions with ICH received less frequent coronary angiography (46.9% vs. 63.8%), percutaneous coronary intervention (22.7% vs. 41.8%), and coronary artery bypass grafting (5.4% vs. 9.2%) as compared to those without (all p<0.001). ICH was associated with a significantly higher in-hospital mortality (41.4% vs. 6.1%; adjusted OR 5.65 [95% CI 5.47-5.84]; p<0.001), and adjusted temporal trends showed a steady decrease in in-hospital mortality over the 18-year period (Figure 1A). AMI-ICH admissions also had longer hospital length of stay, higher hospitalization costs, and greater use of PEG (all p<0.001). In AMI-ICH survivors (N=13, 689), 81.3% had a poor functional outcome indicating severe morbidity and temporal trends revealed a slight increase over the study period (Figure 1B). Conclusions: ICH causes a substantial burden in AMI due to associated higher in-hospital mortality, resource utilization, and poor functional outcomes.

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Difference in the in-hospital prognosis between ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction with high Killip class: Data from the Japan Acute Myocardial Infarction Registry

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872620926681 ◽

2020 ◽

pp. 204887262092668

Author(s):

Motoki Fukutomi ◽

Kensaku Nishihira ◽

Satoshi Honda ◽

Sunao Kojima ◽

Misa Takegami ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Hospital Mortality ◽

Short Term ◽

Term Outcome ◽

Killip Class ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Significant Difference

Background ST-segment elevation myocardial infarction is known to be associated with worse short-term outcome than non-ST-segment elevation myocardial infarction. However, whether or not this trend holds true in patients with a high Killip class has been unclear. Methods We analyzed 3704 acute myocardial infarction patients with Killip II–IV class from the Japan Acute Myocardial Infarction Registry and compared the short-term outcomes between ST-segment elevation myocardial infarction ( n = 2943) and non-ST-segment elevation myocardial infarction ( n = 761). In addition, we also performed the same analysis in different age subgroups: <80 years and ≥80 years. Results In the overall population, there were no significant difference in the in-hospital mortality (20.0% vs 17.1%, p = 0.065) between ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction groups. Patients <80 years of age also showed no difference in the in-hospital mortality (15.7% vs 15.2%, p = 0.807) between ST-segment elevation myocardial infarction ( n = 2001) and non-ST-segment elevation myocardial infarction ( n = 453) groups, whereas among those ≥80 years of age, ST-segment elevation myocardial infarction ( n = 942) was associated with significantly higher in-hospital mortality (29.3% vs 19.8%, p = 0.001) and in-hospital cardiac mortality (23.3% vs 15.0%, p = 0.002) than non-ST-segment elevation myocardial infarction ( n = 308). After adjusting for covariates, ST-segment elevation myocardial infarction was a significant predictor for in-hospital mortality (odds ratio 2.117; 95% confidence interval, 1.204–3.722; p = 0.009) in patients ≥80 years of age. Conclusion Among cases of acute myocardial infarction with a high Killip class, there was no marked difference in the short-term outcomes between ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction in younger patients, while ST-segment elevation myocardial infarction showed worse short-term outcomes in elderly patients than non-ST-segment elevation myocardial infarction. Future study identifying the prognostic factors for the specific anticipation intensive cares is needed in this high-risk group.

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463Temporal trends in latecomer ST-segment elevation myocardial infarction patients: Insights from the AMIS Plus Registry 1997–2017

European Heart Journal ◽

10.1093/eurheartj/ehz747.0122 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Roberto ◽

D Radovanovic ◽

L Biasco ◽

A Quagliana ◽

P Erne ◽

...

Keyword(s):

Myocardial Infarction ◽

Hospital Mortality ◽

Temporal Trends ◽

Late Presentation ◽

Evidence Based ◽

Absolute Rate ◽

Pharmacological Treatments ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment

Abstract Introduction A relevant proportion of patients experiencing ST-segment elevation myocardial infarction (STEMI) has a late presentation after symptoms onset. Temporal trends deriving from a large real-word scenario for this subgroup of patients are lacking. Purpose The aim of the present study was to provide a comprehensive analysis of temporal trends in latecomer STEMI patients, with particular regard to implementation of evidence-based treatments in this population and major in-hospital outcomes. Methods All STEMI patients included in the AMIS Plus Registry from January 1997 to December 2017 were included and patient-related delay was assessed: 27 231 patients were available for the final analysis. STEMI patients were classified as early or latecomers according to patient-related delay (≤ or >12 hours, respectively). Results 22 928 patients were earlycomers (84%) and 4303 patients were classified as latecomers (16%). Across the study period we observed a significant decrease in prevalence of late presentation from 22% to 12.3% (p<0.001, Figure 1). In latecomer STEMI patients there was a gradual uptake of evidence-based pharmacological treatments with an increase in discharge prescription of P2Y12 inhibitors from 6% to 90.7% (p<0.001). Similarly, a marked increase in percutaneous coronary intervention (PCI) rate was observed (12.1–86.6%; p<0.001). Across this 20-year period, in-hospital mortality was reduced to a third (to an absolute rate of 4.5%, p<0.001) and a significant reduction in prevalence of both cardiogenic shock (14.6–4.3%) and re-infarction (5.4–0.2%) during the index hospitalisation was observed (p<0.001 for both variables). Length of hospitalisation in acute care facilities significantly decreased from 10 (6,14) days to 4 (1,7) days (p<0.001). At multivariate analysis, PCI had a strong independent protective effect toward in-hospital mortality (odds ratio 0.3, 95% confidence interval 0.187 to 0.480). Figure 1 Conclusion The present study provides a comprehensive picture of temporal trends in late presentation in STEMI over the last 20 years in Switzerland. During the study period in latecomer STEMI population there was a gradual uptake of evidence-based pharmacological treatments and a marked increase in PCI rate. In-hospital mortality was reduced to a third (to an absolute rate of 4.5%) and this reduction seems to be mainly associated with the increasing implementation of PCI.

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