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This editorial refers to ‘Statistics on mortality following acute myocardial infarction in 842897 Europeans’, by O.A. Alabas et al., pp. 149–157.

Nationalized registry data for the monitoring and improvement of care after acute myocardial infarction have become an important force for implementation of guideline-directed medical therapy and policy change.1,2 These will undoubtedly continue to play a decisive role in our treatment and understanding of contemporary outcomes and treatment practices in aging and increasingly multimorbid global population and as treatments become more accessible in low- and middle-income countries. Even in nations with high incomes, nationalized registry data can highlight important areas for improvement in the delivery of post-myocardial infarction (MI) care. While nationalized registries cannot in themselves impute causality or highlight complex underlying social and behavioural trends, they form the basis of our understanding of the lag between the evidence and actual clinical practice.3,4

While global rates of mortality from acute coronary syndromes (ACS) and ischaemic heart disease, in general, have been on the decline for the past 25 years, this has not been the case for all countries.5 For example, by some reports, mortality rates from ACS continue to rise in India.6 The USA and the UK have seen reductions in mortality from ACS despite increasing patient complexity.5,7 In the USA, during the past 20 years, there have been declining rates of MI-related mortality and increasing rates of in-hospital percutaneous coronary intervention (PCI) but also significant increases in adjusted cost per MI-related hospitalization.8 Other countries have begun to see a plateau in mortality rates from ACS. Sweden saw a consistent decline in mortality from acute myocardial infarction from 1995 to 2009, but since that time has not seen as much improvement.9 South Korea has seen a similar plateau beginning in about 2012.10

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