In recent years, a number of evidence-based interventions for cardiovascular disease have been incorporated into clinical practice guidelines. A recent nationwide study in Sweden analyzed a cohort of 61,238 consecutive patients (mean age 70 years) with first-time ST-elevation myocardial infarction (STEMI) from 1996 through 2007. Over this time period, significant increases in the use of evidence-based procedures and medications were accompanied by significant decreases in mortality (level 2 [mid-level] evidence). Primary percutaneous coronary intervention (PCI) rates increased from 12% to 61%, reperfusion rates (either mechanical or pharmacological) increased from 66% to 79%, and revascularization rates increased from 10% to 84%. Rates of medication use increased from 0 to 82% for clopidogrel, 23% to 83% for statins, and 39% to 69% for ACE inhibitors and ARBS (p for trend < 0.001 for each). Use of aspirin, beta blockers, and calcium channel blockers was also significantly increased. Over the same period, mortality dropped significantly: in-hospital mortality fell from 12.5% to 7.2%, 30-day mortality from 15% to 8.6%, and 1-year mortality from 21% to 13.3% (p for trend < 0.001 for each) (JAMA 2011 Apr 27;305(16):1677).
For more information, see the ST-elevation myocardial infarction (STEMI) topic in DynaMed.