Declining 28-day population myocardial infarction case-fatality trends in Catalonia, Spain: an analysis of the possible contribution of emergency management network

The implementation of emergency care networks for ST-elevation myocardial infarction (STEMI), like Codi IAM in Catalonia, has reduced time to reperfusion. We hypothesized that Codi IAM would decrease the 28-day case-fatality rate for acute myocardial infarction (AMI) by enabling more patients with sudden cardiac death (SCD) to receive timely treatment. We linked the Codi IAM registry, Catalan hospital discharge records, and mortality registry. The study included 97 325 AMI patients aged 35-84 years hospitalized or deceased between 2008 and 2019. We compared trends in prehospital, in-hospital, and overall 28-day standardized case-fatality rates between the preimplementation (2008-10) and implementation periods (2011-19). Annual Percentage Change (APC) and spline trends were analyzed. During the study period, the mean age of AMI patients decreased from 70 to 67 years (P < .001), and the percentage of women declined from 29.2% to 25.7% (P < .001). Comorbidities increased, with higher rates of hypertension (38.8%-49.9%, P < .001), diabetes (23.9%-31.9%, P < .001), and cardiovascular disease history (26.5%-28.5%, P < .001). The overall 28-day AMI case-fatality significantly declined post-2010 (P < .001), mainly due to a decline in prehospital case-fatality (SCD) after 2010 (P < .001). In-hospital case-fatality declined until 2011 (P < .001) and stabilized afterward (P = .12). The decrease in prehospital 28-day AMI case-fatality paralleled the Codi IAM implementation, suggesting a possible transfer of recovered out-of-hospital SCD patients to hospitals, with limited changes in in-hospital mortality rates.