Temporal trends in acute myocardial infarction: What about survival of hospital survivors? Disparities between STEMI & NSTEMI remain. Soroka acute myocardial infarction II (SAMI-II) project

Background Contemporary data on trends of acute myocardial infarction (AMI), particularly outcomes of hospital survivors by AMI type is sparse. Methods Analysis of 11,107 consecutive AMI patients in a tertiary hospital in Israel throughout 2002-2012. The annual incidence of ST-segment elevation (STEMI) and non-ST-segment elevation (NSTEMI) admissions was calculated using age-gender-ethnicity direct adjustment. A multivariate prognostic model was built to evaluate in-hospital and 1-year post-discharge all-cause-mortality, adjusted for patients' risk factors. Results A decline in the adjusted incidence of AMI admissions (per-1000 persons) was documented (2002 vs. 2012) for STEMI: 4.70 vs. 1.38 (p < 0.001) and non-significant tendency of increase for NSTEMI: 1.86 vs. 2.37 (p = 0.109). The prevalence of most cardiovascular risk-factors, some non-cardiovascular comorbidities and invasive interventions increased. In-hospital mortality declined significantly for STEMI: 10.8% vs. 7.7% (p < 0.001) and with no change for NSTEMI: 5.0% vs. 5.5% (p = 0.137). Consistently, 1-year post-discharge mortality declined for STEMI: 13% vs. 5.9% (p < 0.001) and with a non-significant increase for NSTEMI: 12.6% vs. 17.0% (p = 0.377). Adjusting for the risk factors, an increase of one year was associated with a decline of in-hospital mortality for STEMI: AdjOR = 0.86 (p < 0.001) and for NSTEMI: AdjOR = 0.92 (p < 0.001). However, the risk for post-discharge mortality increased for STEMI: AdjOR = 1.11 (p < 0.001) and for NSTEMI: AdjOR = 1.12 (p < 0.001). Conclusions Throughout 2002-2012 significant decline in the incidence and of in-hospital mortality of STEMI were found. However, adjusted post-discharge mortality rates increased significantly with time. Measures for improving incidence and outcomes of AMI patients focusing on NSTEMI and hospital-survivors are warranted.