Long-term outcomes in ST-segment elevation myocardial infarction (STEMI) vary according to adherence to guideline-based performance measures after percutaneous coronary intervention (PCI). This multicenter registry analysis, published in Circulation: Cardiovascular Quality and Outcomes, evaluated the association between adherence to performance measures and long-term clinical outcomes.

The CREDO-Kyoto Acute Myocardial Infarction (AMI) Registry Wave-2 included 2892 patients with STEMI who underwent coronary revascularization within 24 hours of symptom onset and survived to hospital discharge across 22 centers in Japan. Adherence was defined based on nine guideline-recommended performance measures, including early reperfusion, evidence-based pharmacotherapy, and cardiac rehabilitation. Patients were categorized by the number of fulfilled measures (PMs=9, 8, 7, or ≤6).

Over a median follow-up of 6.0 years, five-year all-cause mortality increased from 8.9% in patients meeting all nine measures to 23.6% in those meeting six or fewer. Compared with PMs=9, adjusted hazard ratios (HRs) for all-cause mortality were 1.14 (95% CI, 0.83–1.57) for PMs=8, 1.36 (0.99–1.87) for PMs=7, and 1.96 (1.43–2.69) for PMs≤6.

Similar patterns were observed for most secondary outcomes, including cardiovascular death, myocardial infarction, stroke, heart failure hospitalization, and major bleeding, while repeat coronary revascularization showed no differences across adherence groups.

Lower adherence to performance measures corresponded with higher long-term risk of adverse outcomes in STEMI.