Early and Sudden Deaths after Myocardial Infarction

Abstract

ABSTRACT. 1329 patients were discharged alive after acute myocardial infarction initially treated in a CCU. In a five‐year follow‐up, 537 (40%) of the patients died. Routine data registered uniformly during the CCU period showed that, apart from age, the most important factors regarding long‐term prognosis in general were previous ischaemic heart disease and direct or indirect signs of heart failure registered in the CCU. The possibilities to predict sudden death (130 patients died within 2 hours of onset of final symptoms during the follow‐up period) were small, although a definite dominance of this mode of death was noted in patients below 60 years of age. The clinical profile of the majority of the 134 patients who died during the first half‐year was distinguished by a history of prior myocardial infarction and signs of left heart failure during the CCU stay. However, in a significant number of patients dying early after discharge, none of the ordinary unfavourable prognostic signs had been registered.

Predicting Long‐term Mortality after a Myocardial Infarction from Routine Hospital Data

“…However, when examined in relation to the expected mortality, the effect of age that could be attributed to the MI per se was not found to be significant. This is in contrast to the findings of Kjgller (19) and Helmers & Lundman (9), who both demonstrated a clearly higher relative mortality in MI patients of younger age. Again, a hypothetical explanation could be that present standards of medical and surgical treatment have improved the prognosis in younger patients more than in older coronary heart patients.…”

“…The negative effect of the severity of the index MI has not only been documented for the immediate and short-term prognosis, but for late survival as well. As in the present study, evidence of pulmonary congestion has often been found to be an important prognostic factor (2-4, 6,9,12,18,19,22). Although a strict standardization of the clinical observations was not undertaken, the finding that patients noted to have pulmonary crepitations and/or radiological evidence of pulmonary congestion during hospitalization later had twice the mortality as other patients supports the validity of these observations.…”

“…The relative mortality for MI patients compared with a "normal" population was found to be lower than previously published estimates. In studies dealing with patients under 70 years of age, the ratio between observed and expected deaths during the first post-MI year has been calculated to be between 9.4 and 14.7, and for the next two years between 5.8 and 7.7 (9,11,19). Although comparisons are rendered difficult due to differences in patient populations-especially with regard to age-the lower relative mortality in this study could be an indication of the improvement in long-term survival after a MI that has been observed during the past few decades (20,21).…”

“…Long-term prognosis after the acute phase of a myocardial infarction (MI) has been studied in a number of investigations (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12) (Table I). Of patients under 70 years of age, between 67% and 74% survive the first 5 years (1, 10, 11).…”

QTC Intervals at Discharge after Acute Myocardial Infarction and Long‐Term Prognosis

“…Several studies have pointed to the feasibility of estimating prognosis after an AM1 (7, 12, 17). However, a number of patients dying early after discharge carry none of the ordinary unfavourable prognostic signs (14). This warrants a search for new prognostic factors that may increase our pre-S .…”