title: Determinants of improved one-year survival in non-ST-segment elevation myocardial infarction patients: insights from the French FAST-MI program over 15 years.
abstract: BACKGROUND
  Improved early outcome in non-ST elevation myocardial infarction (NSTEMI) patients has been mainly attributed to a broader use of invasive strategies. Little is known about the impact of other changes in early management.
  
  
  METHODS
  We aimed to assess 15-year trends in one-year mortality and their determinants in NSTEMI patients. We used data from 4 one-month French registries, conducted 5 years apart from 1995 to 2010 including 3903 NSTEMI patients admitted to intensive care units.
  
  
  RESULTS
  From 1995 to 2010, no major change was observed in patient characteristics, while therapeutic management evolved considerably. Early use of antiplatelet agents, β-blockers, ACE-inhibitors and statins increased over time (P < 0.001); use of newer anticoagulants (low-molecular-weight heparin, bivalirudin or fondaparinux) increased from 40.8% in 2000 to 78.9% in 2010 (P < 0.001); percutaneous coronary intervention (PCI)≤ 3 days of admission rose from 7.6% to 48.1% (P < 0.001). One-year death decreased from 20% to 9.8% (HR adjusted for baseline parameters, 2010 vs. 1995 = 0.47, 95% CI: 0.35-0.62). Early PCI (HR = 0.67; 95% CI: 0.49-0.90), use of newer anticoagulants (HR = 0.62; 95% CI: 0.48-0.78) and early use of evidence based medical therapy (HR = 0.54; 95% CI: 0.40-0.72) were predictors of improved one year-survival.
  
  
  CONCLUSIONS
  One-year mortality of NSTEMI patients decreased by 50% in the past 15years. Our data support current guidelines recommending early invasive strategies and use of newer anticoagulants for NSTEMI, and also show a strong positive association between early use of appropriate medical therapies and one-year survival, suggesting that these medications should be used from the start.
authors.affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, 75015 Paris, France; Université Paris-Descartes, 75006 Paris, France; INSERM U-970, 75015 Paris, France. Electronic address: etiennepuymirat@yahoo.fr.
authors.forename: Etienne
authors.initials: E
authors.lastname: Puymirat
authors.affiliation: University Hospital Jean Minjoz, Department of Cardiology, 25030 Besançon, France.
authors.forename: François
authors.initials: F
authors.lastname: Schiele
authors.affiliation: AP-HP, Hôpital Bichat, Paris, France; Université Paris-Diderot, Sorbonne Paris-Cité, 75018 Paris, France; INSERM U-970, 75018 Paris, France.
authors.forename: Philippe Gabriel
authors.initials: PG
authors.lastname: Steg
authors.affiliation: Clinique St Gatien, 37000 Tours, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Blanchard
authors.affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, 75015 Paris, France; Université Paris-Descartes, 75006 Paris, France.
authors.forename: Marc-Antoine
authors.initials: MA
authors.lastname: Isorni
authors.affiliation: Institut de Cardiologie, Centre Hospitalier Pitié-Salpêtrière, 75013 Paris, France.
authors.forename: Johanne
authors.initials: J
authors.lastname: Silvain
authors.affiliation: Lille Regional University Hospital, Emergency Department, 59037 Lille, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Goldstein
authors.affiliation: University Hospital Henri Mondor, Department of Cardiology, 94010 Créteil, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Guéret
authors.affiliation: Société Française de Cardiologie, 75012 Paris, France.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Mulak
authors.affiliation: AP-HP, Hôpital Saint Antoine, Department of Clinical Pharmacology and Centre de Recherche Clinique (URCEST), 75012 Paris, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Berard
authors.affiliation: Toulouse University Hospital, Department of Cardiologie B and Epidemiology, Toulouse, France; INSERM U-558, 31059 Toulouse, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Bataille
authors.affiliation: Intercity Hospital Le Raincy-Montfermeil, Department of Cardiology, 93370 Montfermeil, France.
authors.forename: Simon
authors.initials: S
authors.lastname: Cattan
authors.affiliation: Toulouse Rangueil University Hospital, Department of Cardiology, France; UMR1027, INSERM, 31059 Toulouse, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Ferrières
authors.affiliation: AP-HP, Hôpital Saint Antoine, Department of Clinical Pharmacology and Unité de Recherche Clinique (URCEST), 75012 Paris, France; Université Pierre et Marie Curie (UPMC-Paris 06), France; INSERM U-698, 75012 Paris, France.
authors.forename: Tabassome
authors.initials: T
authors.lastname: Simon
authors.affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, 75015 Paris, France; Université Paris-Descartes, 75006 Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danchin
mesh_terms: D000368:Aged; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends
chemical_list: D002317:Cardiovascular Agents
keywords: Coronary artery disease; Mortality; Non-ST-elevation myocardial infarction; Percutaneous coronary intervention