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

Background There 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. Objectives We 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). Methods Outcomes were examined using both descriptive and regression analysis to control for differences in patient clinical characteristics over time. Results The 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. Conclusions Despite 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. ### Competing Interest Statement Zoll Medical Corporation funded the data analysis for the preparation of this manuscript. There are no other potential conflicts to disclose. ### Funding Statement Zoll Medical Corporation funded the data analysis for the preparation of this manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Medicare data I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors