New study examines differences in mortality after myocardial infarction

“Our results show that other factors also affect patient survival,” says Moman A Mohammad, consultant cardiologist.
A new study shows differences in mortality among patients with a severe form of myocardial infarction treated at different hospitals in Skåne, Sweden. Patients treated at Skånes universitetssjukhus had lower mortality than patients treated at other hospitals included in the study, despite a longer time before treatment could be initiated.

In patients with ST-elevation myocardial infarction (STEMI), rapid treatment to restore blood flow in the coronary arteries is crucial. At the same time, the new study, published in European Heart Journal – Quality of Care and Clinical Outcomes, shows that time to treatment is not the only factor that may affect patient outcomes.

Lower STEMI mortality at high volume tertiary centre: Insights from a compact multi-centre region - PubMed

The researchers studied 3,344 patients with STEMI who underwent coronary angiography at one of four hospitals in Region Skåne between 1 January 2015 and 15 August 2025. Of these, 1,876 patients were treated at Skånes universitetssjukhus and 1,468 at the other hospitals.

At 30 days, mortality was 5.1 per cent among patients treated at Skånes universitetssjukhus, compared with 8.6 per cent among patients treated at the other hospitals.

Differences in mortality were also observed at one and three years. At one year, mortality was 8.2 per cent compared with 11.8 per cent, and at three years, 13.6 per cent compared with 17.5 per cent. At five years, there was no statistically significant difference in mortality between the groups.

At the same time, the time from ECG to treatment was longer at Skåne University Hospital – a median of 91 minutes compared with 53 minutes at the other hospitals. The times for both patient groups were within the recommended thresholds for transfer for treatment.

“Rapid treatment remains very important for this type of myocardial infarction. At the same time, our results show that other factors also affect patient survival,” says Moman A Mohammad, consultant in cardiology at Skåne University Hospital and associate professor at Lund University, and senior author of the study.

Annika Adgård, nurse, Moman A Mohammad, consultant cardiologist, and Mats Birgander, senior consultant in cardiology, carry out a cardiac procedure.

The study shows an association between where patients were treated and differences in mortality, but it cannot establish with certainty what caused the observed results.

Patients at Skåne University Hospital were more likely to undergo intracoronary imaging and to receive inotropic medication or mechanical circulatory support. The hospital also treats a large number of patients with STEMI and has extensive experience in managing this type of myocardial infarction. However, the study cannot determine the extent to which these factors contributed to the results.

“More intensive treatment would normally be a sign that patients are more severely ill and therefore have a poorer prognosis. In our study, however, we see lower mortality in the group in which patients were more likely to receive more intensive treatment. This may indicate that the right patients received the right treatment at the right time, but our study cannot establish this,” says Moman A Mohammad.

He also emphasises that myocardial infarction care at the other hospitals in the region is in line with the national average. Survival after myocardial infarction is continuously monitored through the national SWEDEHEART quality registry.

“All hospitals in Skåne provide very good care for patients with myocardial infarction. The study raises questions about what may underlie the differences, and this is something we need to continue investigating,” says Moman A Mohammad.

Patrik Tydén, Head of the Department of Cardiology at Skåne University Hospital.

The study is based on a specific organisation of STEMI care in Skåne. During weekday daytime hours, patients from certain catchment areas are treated at their local hospitals in Skåne. During on-call hours, patients from the same areas are instead transferred to Skånes universitetssjukhus.

This means that patients from the same geographical areas may be treated at different hospitals depending on the time at which they present for care.

The researchers suggest that the findings may be relevant to the organisation of STEMI care in regions where distances between hospitals are relatively short. At the same time, the results cannot be directly extrapolated to areas with longer distances.

“Researching our own healthcare is important so that we can learn and develop together. When we see differences, we need to try to understand what causes them and what we can learn from them. This study suggests that the organisation of STEMI care may affect patient outcomes. It gives us reason to continue investigating this issue and developing care together across Region Skåne,” says Patrik Tydén, Head of the Department of Cardiology at Skåne University Hospital.

Last updated: 2026-09-16