Ten-Year Trends in Patient Characteristics, Treatments, and Outcomes in Myocardial Infarction From National Cardiovascular Data Registry Chest Pain–MI Registry

Abstract

Background: The Chest Pain–MI registry affords a 10-year perspective of the acute myocardial infarction (MI) patient characteristics, management, and clinical outcomes in the United States. We report the changes in the treatment and cardiovascular outcomes of acute MI patients over 10 years. Methods: Annual trends in patient characteristics, in-hospital treatment, and outcomes of 604 936 ST-segment–elevation MI (STEMI) and 933 755 non–ST-segment–elevation MI (NSTEMI) patients at 1230 hospitals from 2009 to 2018 were analyzed. Using the validated Acute Coronary Intervention and Outcomes Network mortality risk model, trends in in-hospital risk-adjusted mortality rates were tested between 2011 and 2018. Results: Over 10 years, the prevalence of diabetes (22.8%–28.3% [STEMI] and 35.7%–41.3% [NSTEMI]) and atrial fibrillation (4.1%–6.1% and 9.4%–11.7%) increased, whereas the prevalence of smoking decreased (43.5%–37.9% and 30.2%–27.5%, P <0.001 for all) in patients with STEMI and NSTEMI, respectively. Among eligible patients with STEMI, primary percutaneous coronary intervention use increased (82.3%–96.0%) with shorter median first medical contact to device time (90 to 82 minutes, P <0.001). Among patients with NSTEMI, percutaneous coronary intervention use increased significantly (43.9%–54.5%, P <0.001). Adherence to guideline-directed medical therapies improved in both groups. From 2011 to 2018, risk-adjusted mortality rate (2.8%–2.7%, P =0.46) was stable in STEMI and declined significantly in patients with NSTEMI (1.9%–1.3%, P =0.0001). Conclusions: Risk factors of patients presenting with acute MI have changed modestly while treatment improved over time. Risk-adjusted mortality rates remained stable for patients with STEMI and declined significantly for patients with NSTEMI.