Abstract Aims Impact of changes of treatments on outcomes in ST-elevation myocardial infarction (STEMI) patients in real-life health care has not been documented. Methods and results All STEMI cases (n = 105.674) registered in the nation-wide SWEDEHEART registry between 1995 and 2014 were included and followed for fatal and non-fatal outcomes for up to 20 years. Most changes in treatment and outcomes occurred from 1994 to 2008. Evidence-based treatments increased: reperfusion from 66.2 to 81.7%; primary percutaneous coronary intervention: 4.5 to 78.0%; dual antiplatelet therapy from 0 to 89.6%; statin: 14.1 to 93.6%; beta-blocker: 78.2 to 91.0%, and angiotensin-converting-enzyme/angiotensin-2-receptor inhibitors: 40.8 to 85.2% (P-value for-trend <0.001 for all). One-year mortality decreased from 22.1 to 14.1%. Standardized incidence ratio compared with the general population decreased from 5.54 to 3.74 (P < 0.001). Cardiovascular (CV) death decreased from 20.1 to 11.1%, myocardial infarction (MI) from 11.5 to 5.8%; stroke from 2.9 to 2.1%; heart failure from 7.1 to 6.2%. After standardization for differences in demography and baseline characteristics, the change of 1-year CV-death or MI corresponded to a linear trend of 0.915 (95% confidence interval: 0.906–0.923) per 2-year period which no longer was significant, 0.997 (0.984–1.009), after adjustment for changes in treatment. The changes in treatment and outcomes were most pronounced from 1994 to 2008. Conclusion Gradual implementation of new and established evidence-based treatments in STEMI patients during the last 20 years has been associated with prolonged survival and lower risk of recurrent ischaemic events, although a plateauing is seen since around 2008.

中文翻译：

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过去 20 年 ST 段抬高心肌梗死患者预后的改善与循证治疗的实施有关：1995-2014 年 SWEDEHEART 登记处的经验

摘要 目的 治疗改变对 ST 段抬高心肌梗死 (STEMI) 患者在现实生活中的医疗保健结果的影响尚未被记录。方法和结果 纳入 1995 年至 2014 年间在全国 SWEDEHEART 登记处登记的所有 STEMI 病例（n = 105.674），并对其致命和非致命结果进行长达 20 年的随访。治疗和结果的大部分变化发生在 1994 年至 2008 年。循证治疗增加：再灌注从 66.2% 增加到 81.7%；初次经皮冠状动脉介入治疗：4.5% 至 78.0%；双重抗血小板治疗从 0 到 89.6%；他汀类药物：14.1 至 93.6%；β-受体阻滞剂：78.2% 至 91.0%，血管紧张素转换酶/血管紧张素 2 受体抑制剂：40.8% 至 85.2%（所有趋势的 P 值 <0.001）。一年死亡率从 22.1% 下降到 14.1%。与一般人群相比，标准化发病率从5.54下降到3.74（P < 0.001）。心血管（CV）死亡率从 20.1% 下降到 11.1%，心肌梗塞（MI）从 11.5% 下降到 5.8%；中风从 2.9% 到 2.1%；心力衰竭从 7.1% 增加到 6.2%。在对人口统计学和基线特征的差异进行标准化后，1 年 CV 死亡或 MI 的变化对应于每 2 年期间 0.915（95% 置信区间：0.906-0.923）的线性趋势，不再显着，0.997 (0.984–1.009)，在调整治疗变化后。从 1994 年到 2008 年，治疗和结果的变化最为明显。