Differences in treatment and outcome of patients with ST- elevation myocardial infarction (STEMI) and non-STEMI in Germany

BACKGROUND: Although ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) are very similar regarding pathophysiology and clinical treatments, especially NSTEMI comprises a much more heterogenic group of patients and underlying diseases. We therefore aimed to assess the treatments and outcomes of both entities in a large contemporary cohort. METHODS: Patients with STEMI and NSTEMI between 01/01/2010-31/12/2018 were identified from the largest German health insurance (AOK, ≈ 26 million members). Patient demographics, their hospital course, adherence to guideline-directed drug therapy and overall survival were assessed. RESULTS: In total 544,529 patients (mean age 74, IQR 62-82), one third of whom had a STEMI. Chronic kidney disease, peripheral arterial disease, and heart failure were more common in patients with NSTEMI. Patients with STEMI were more likely to get coronary angiograms and percutaneous coronary interventions. Although STEMI more frequently led to cardiogenic shock, the rate of serious cardiac events was lower. Mortality was higher for STEMI only within the first 30 days, whereas long-term survival rates were better. The combination of statins, angiotensin converting enzyme inhibitors/angiotensin receptor blockers, beta blockers, and oral anticoagulants or antiplatelet agents was associated with higher overall survival in patients with STEMI (hazard ratio [HR] 0.21; 95% confidence interval [95%CI] 0.20-0.23; p < 0.001) or NSTEMI (HR 0.40; 95%CI 0.38-0.42; p < 0.001). Nevertheless, the prescription rates decreased over time, particular in patients with NSTEMI. CONCLUSION: Clear differences between STEMI and NSTEMI were observed regarding short- and long-term survival. Guideline-recommended therapy improved long-term survival, but decreased during the follow-up period.