Cardiovascular

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

Lange S, Engelbertz C, et al. • PloS one • 2026

PubMed 42879374 DOI 10.1371/journal.pone.0343889
TL;DR

Clear differences between STEMI and NSTEMI were observed regarding short- and long-term survival, and guideline-recommended therapy improved long-term survival but decreased during the follow-up period.

Key Findings

Results

STEMI patients had higher 30-day mortality but better long-term survival compared to NSTEMI patients.

  • Mortality was higher for STEMI only within the first 30 days, whereas long-term survival rates were better.
  • The cohort included 544,529 patients with mean age 74 (IQR 62-82), one third of whom had a STEMI.
  • Data was drawn from AOK, the largest German health insurance with approximately 26 million members, covering the period 01/01/2010 to 31/12/2018.
Results

Guideline-directed combination drug therapy was associated with significantly higher overall survival in both STEMI and NSTEMI patients.

  • The combination of statins, ACE inhibitors/ARBs, beta blockers, and oral anticoagulants or antiplatelet agents was assessed.
  • In STEMI patients, this combination was associated with a hazard ratio of 0.21 (95% CI 0.20-0.23; p < 0.001).
  • In NSTEMI patients, the hazard ratio was 0.40 (95% CI 0.38-0.42; p < 0.001).
  • The survival benefit was stronger in STEMI patients than in NSTEMI patients based on the hazard ratios.
Results

Prescription rates of guideline-recommended therapy decreased over the follow-up period, particularly in NSTEMI patients.

  • The decline in prescription rates was observed across the 2010-2018 study period.
  • The decrease was described as particularly pronounced in patients with NSTEMI.
  • This trend occurred despite the demonstrated survival benefit of the combination therapy.
Results

STEMI patients were more likely to receive invasive coronary procedures than NSTEMI patients.

  • Patients with STEMI were more likely to get coronary angiograms and percutaneous coronary interventions (PCI).
  • Although STEMI more frequently led to cardiogenic shock, the rate of serious cardiac events was lower in STEMI compared to NSTEMI.
  • These differences reflect the more acute and uniform presentation of STEMI compared to the heterogeneous NSTEMI population.
Results

NSTEMI patients had a higher burden of comorbidities compared to STEMI patients.

  • Chronic kidney disease, peripheral arterial disease, and heart failure were more common in patients with NSTEMI.
  • NSTEMI comprises a much more heterogenic group of patients and underlying diseases.
  • The study population included 544,529 patients total, with approximately two thirds classified as NSTEMI.
Methods

The study cohort was elderly, with a mean age of 74 years and an interquartile range of 62-82 years.

  • Total cohort size was 544,529 patients identified from AOK insurance claims data.
  • One third of patients had a STEMI and two thirds had an NSTEMI.
  • Patient demographics, hospital course, guideline-directed drug therapy adherence, and overall survival were all assessed.

What This Means

This research studied over 544,000 heart attack patients in Germany between 2010 and 2018, comparing two types of heart attacks: STEMI (where a major artery is completely blocked) and NSTEMI (a less complete blockage). The data came from Germany's largest public health insurer. The study found that while STEMI patients were more likely to die in the first 30 days after their heart attack, those who survived tended to do better in the long run compared to NSTEMI patients. NSTEMI patients, on average, were sicker overall — they more commonly had kidney disease, poor circulation in their legs, and heart failure — which likely contributes to their worse long-term outlook despite a lower immediate death rate. The study also found that a combination of four standard heart medications — statins (cholesterol-lowering drugs), blood pressure medications (ACE inhibitors or ARBs), beta blockers, and blood thinners — was strongly linked to better survival in both groups. Patients with STEMI who received all four medications had about an 80% lower risk of death compared to those who did not, while NSTEMI patients had about a 60% lower risk. Despite this clear benefit, the proportion of patients actually receiving this combination of medications declined over the nearly decade-long study period, with the drop being especially notable among NSTEMI patients. This research suggests that there is a significant gap between what guidelines recommend and what patients actually receive, particularly for NSTEMI. Since NSTEMI patients represent the larger and sicker group, improving adherence to evidence-based medication regimens in this population could have a substantial impact on survival outcomes. The findings highlight the need for better follow-up care and medication management after heart attacks, especially for the more complex NSTEMI patient group.

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Citation

Lange S, Engelbertz C, Makowski L, Dr&#xf6;ge P, Ruhnke T, G&#xfc;nster C, et al.. (2026). Differences in treatment and outcome of patients with ST- elevation myocardial infarction (STEMI) and non-STEMI in Germany.. PloS one. https://doi.org/10.1371/journal.pone.0343889