In a large observational study, patients who survived to three months had only slightly higher 10-year mortality compared with the general population.

Although mortality risk is high shortly after ST­segment elevation myocardial infarction (STEMI), long-term mortality risk in a population treated with contemporary invasive and medical management is not well described.

Using a population-­based registry, researchers identified nearly 19,000 patients with first-­time STEMI under­ going primary percutaneous coronary intervention (PCI) in Western Denmark between 2003 and 2018. They matched each patient by age and sex to five individuals from the general population without known coronary artery disease. The median age was 64 years, and 26% were women.

Baseline comorbidities were similar between groups. Compared with controls, mortality was significantly increased in the STEMI cohort from 0 to 90 days (particularly within the first 30 days) but in 90-­day STEMI survivors, mortality was only slightly elevated at 10 years (cumulative mortality, 27% vs 25% in controls). Subgroups in the STEMI cohort with excess mortality between 90 days and 10 years were patients aged younger than 65 years, women, active smokers and those with hypertension, diabetes, multivessel disease or heart failure. Fewer than 20% of the STEMI cohort reported use of cardio­vascular medical therapy (aspirin, statin or beta blocker) at presentation. Within one year after STEMI, most patients were on secondary prevention medications, and although adherence decreased slightly over time, most patients remained on them at 10 years.

Comment: While data from this large registry are encouraging for patients who survive 90 days after a first STEMI, they highlight low rates of primary prevention. I agree with the authors of the accompany­ing editorial that improved primary prevention, particularly in the groups that suffered worse outcomes, should be a priority. Accordingly, I will engage with primary care and specialty providers at my institution, both to disseminate these findings and to learn how our cardio­vascular group can support implementa­ tion efforts to improve primary prevention.

Shea E. Hogan, MD, MSCS, FACC, FSCAI, FSVM, Interventional Cardiologist, Denver Health; Associate Professor of Clinical Medicine, University of Colorado School of Medicine; Clinician-Scientist, CPC Clinical Research, Denver, USA.

Thrane PG, et al. 10-year mortality after ST-segment elevation myocardial infarction compared to the general population. J Am Coll Cardiol 2024; 83: 2615-2625.

Weisfeldt ML, Sisson SD. Evaluating long-term care after ST-segment myocardial-infarction with a population-based comprehensive medical record. J Am Coll Cardiol 2024; 83: 2626-2628.

This summary is taken from the following Journal Watch titles: Cardiology, Hospital Medicine.