Trends in management, morbidity and mortality of patients with acute myocardial infarction hospitalized in the last decade

Background: The diagnosis and management of acute myocardial infarction (AMI) has undergone major changes during the last decade. These changes reflect the results of numerous controlled clinical trials that established the basis for evidence-based guidelines. Aims: The aims of this study were to examine the trends in the characteristics, management and outcome of patients with AMI, hospitalized in all 25 Intensive Care Units (ICCU) operating in Israel during the last decade (1994-2004). Methods: Data were derived from the biannual two-month national AMI/Acute Coronary Syndrome Israeli Surveys (ACSIS) performed in Israel. During the last decade, there was a continuous increase in the number of AMI patients admitted to the ICCU's operating in Israel - 999 AMI patients in 1994 and 1,534 in 2004. This increase was possibly due to shortening of hospital stay of AMI patients. Results: The mean age of patients (64 years) did not change significantly in the last decade. The ICCU population has been characterized by an increasing number of octogenarians (7% in 1994 and 13% in 2004) and higher numbers of patients with past history of PCI, CABG, CVA and other comorbidities. There have been increases in the use of evidence-based medications during hospital stays and at discharge, reflecting greater adherence to guidelines. The primary reperfusion rate increased in the last decade from 60% in 1998 to 64% in 2004 The mode of reperfusion has changed in favor of primary PCI in 2004. In 1998, 88% of STEMI patients who underwent primary reperfusion were treated with thrombolysis and 12% by primary PCI while in 2004, 33% were treated with thrombolysis and 67% by primary PCI. The hospital course of patients with AMI in the last decade is characterized by better outcomes with reductions in rates of reischemia and reinfarction, cardiogenic shock, atrial fibrillation, VT/VF, and AV Block 2o-3o. The most striking change in the last decade is the significant reduction in short- and long-term mortality with 45% reduction in 7-day mortality and 33% reduction in one-year mortality. Conclusions: This trend of better clinical outcomes and lower mortality in the last decade most probably relates to the use of evidence-based treatment and to better adherence to guidelines in the operating ICCUs in Israel.