Abstract 12883: Trends in Clinical Characteristics and Mortality in STEMI Patients Over Two Decades: Insights From the Midwest STEMI Consortium

Introduction: The past two decades have witnessed the evolution of percutaneous intervention technologies, advancements in post-STEMI cardiac care, and initiatives to improve STEMI systems of care. We aimed to explore the impact on STEMI management and prognosis in well-established regional STEMI systems. Methods: We examined the trends in clinical characteristics, management, and mortality in 12,879 consecutive STEMI patients between the periods of 2003-2009 (n=4,159) and 2010-2020 (n=8,720) using the Midwest STEMI Consortium; which consists of regional and tertiary STEMI centers with standardized STEMI protocols. Results: In 2010-2020, patients were older, more frequently female, and with a higher prevalence of previous MI, hypertension, dyslipidemia, and diabetes compared with the 2003-2009 period. In 2010-2020, patients were more likely to be treated with PCI, had shorter reperfusion times, and were more likely to receive guideline-directed medical therapy (GDMT) at discharge. Out-of-hospital cardiac arrest (OHCA) was more frequent in the 2010-2020 period (8.7% vs 10%, p=0.025), while the rate of cardiogenic shock was similar. In-hospital mortality was higher in the 2010-2020 period (4.7% vs 5.6%, p=0.037); while the post-discharge to 1-year mortality was lower (5.8% vs 4.4%, p=0.053) (Table). Conclusions: In a well-established consortium of regional STEMI systems, the patient population has become at higher risk but STEMI management has improved with higher PCI rates, lower reperfusion time, and higher rates of GDMT, leading to lower post-discharge to 1-year mortality risk. In-hospital mortality risk was higher in the 2010-2020 period likely related to a higher cardiovascular risk profile, in particular, the increased number of OHCA in the last decade.