Hospital mortality of acute myocardial infarction in the thrombolytic era

Abstract

Objective-To examine the management and outcome of an unselected consecutive series of patients admitted with acute myocardial infarction to a tertiary referral centre. Design-A historical cohort study over a three year period (1992-94) of consecutive unselected admissions with acute myocardial infarction identified using the HIPE (hospital inpatient enquiry) database and validated according to MONICA criteria for definite or probable acute myocardial infarction. Setting-University teaching hospital and cardiac tertiary referral centre. Results-1059 patients were included. Mean age was 67 years; 60% were male and 40% female. Rates of coronary care unit (CCU) admission, thrombolysis, and predischarge angiography were 70%, 28%, and 32%, respectively. Overall inhospital mortality was 18%. Independent predictors of hospital mortality by multivariate analysis were age, left ventricular failure, ventricular arrhythmias, cardiogenic shock, management outside CCU, and reinfarction. Hospital mortality in a small cohort from a non-tertiary referral centre was 14%, a diVerence largely explained by the lower mean age of these patients (64 years). Five year survival in the cohort was 50%. Only age and left ventricular failure were independent predictors of mortality at follow up. Conclusions-In unselected consecutive patients the hospital mortality of acute myocardial infarction remains high (18%). Age and the occurrence of left ventricular failure are major determinants of short and long term mortality after acute myocardial infarction. (Heart 1999;81:478-482)

Pharmacological management of acute myocardial infarction in the municipal district of Rio de Janeiro

“…The USA Second National Registry of Myocardial Infarction (1994 to 1998) reported a 19.7% mortality; when the analysis excluded cases that were transferred from or to other hospitals, the mortality fell to 13.6%. 17 A multicentric Norwegian study showed a mortality of 18% in 1999; 9 a multicentric Irish study found 18% in the period 1992-1994; 10 the multicentric English study in Nottingham, 21.7% in 1992. 11 Among the Brazilian studies of non-selected cases, there are two that use AIH, describing a mortality of 17.1% in the state of São Paulo in 1997 16 and 18.4% in the state of Rio de Janeiro in 1995.…”

“…There is a huge variation in therapeutic patterns for acute myocardial infarction reported from around the world, often showing non-adherence to wellestablished protocols. [5][6][7][8][9][10][11][12][13][14][15] There is also a huge variation in the hospital mortality observed in different hospitals. This variation may be related, among other reasons, to differences in the severity of the cases, as well as to differences in the quality of medical care.…”

Bone marrow-derived stem cells for ischemic hearts

“…In Western societies heart failure is primarily the consequence of previous myocardial infarction [1]. As new modalities have emerged which have enabled significant reduction in early mortality from acute myocardial infarction there has been a paradoxical increase in the incidence of postinfarction heart failure among the survivors.…”

Effective Variations on Acute Myocardial Infarction in the Elderly in a City in West of Turkey

“…More than half of deaths from cardiovascular disease are due to acute myocardial infarction (aMI) (3)(4)(5). Although aMI is thought of as a middle-aged man's disease, 60% of aMI is seen in those over 65 years of age, and approximately 30% is seen in patients 75 years of age and older (6).…”