485 prognostic impact of treatments evolution in stemi: insights from a primary pci registry

Abstract Objective We aimed to evaluate in a real world primary percutaneous coronary intervention (pPCI) registry the impact of the evolution of evidence-based treatments on prognosis, comparing different decades of treatment. Methods Consecutive STEMI patients undergoing pPCI at University Hospital of Trieste, Italy, were enrolled in a pPCI registry. Outcomes were evaluated during two successive periods: the first cohort (old treatments cohort) included STEMI patients treated between January 2007 and December 2012, and the second cohort (new treatments cohort), included STEMI patients treated between January 2013 and December 2020. Cox regression models were performed to predict the risk of the study primary endpoint (PE) a composite of all cause death, reinfarction and re-PCI at 5 years. The secondary endpoint was all cause of mortality at 5 years. Moreover, we evaluated the incidence of stent thrombosis at 12 months. Results A total of 2425 STEMI patients, 947 in the old treatments cohort and 1478 in the new treatments cohort were analysed. The mean age of the population was 66 ± 12.5 years, most were males (74.3%), 20.2% were diabetics, and 12% presented in Killip class III-IV. At 5-years of follow-up the new treatments cohort compared to the old treatments cohort presented a lower rate of primary outcome (18.5% vs 23.1%, p=0.006) and mortality (15.5% vs 19.9%, p=0.006). At Cox regression model adjusted for baseline differences between the two cohorts, patients in the new treatments cohort had lower risk of PE (HR 0.717, 95% CI 0.567–0.907, p=0.006) and mortality (HR 0.662, 95% CI 0.509–0.860, p=0.002). When considering both clinical and procedural variables, complete revascularization (HR 0.459, 95% CI 0.265–0.796, p=0.006) and the administration of prasugrel or ticagrelor (HR 0.721, 95% CI 0.524–0.992, p=0.013) were independent predictors of PE as well as of 5 years mortality. The new treatments cohort compared to the old treatments cohort had more frequent use of radial approach (83.1% vs 24.4%, p<0.001) and had lower ischaemia time (3.05 vs 3.45 hours, p>0.001), however they were not associated with PE. Patients receiving prasugrel or ticagrelor or drug eluting stent (DES) were at lower risk of stent thrombosis at 12 months (HR 0.502, 95% CI 0.280–0.900, p=0.021). Conclusions In a real-word STEMI population the prognosis of patients is improved in the last decades, and this was associated to the use of new antithrombotic treatments and to the implementation of complete revascularization. The application of new evidence-based therapies in clinical practise is fundamental to improve patient prognosis because the benefits demonstrated by clinical trials have translated into a benefit in the real-world population.