Prognosis after myocardial infarction. Six-year follow-up.

Abstract

The mortality pattern occurring 3 to 6 years after recovery from myocardial infarction is described in a group of 349 patients. Mortality in this group had been previously related to prognostic factors recorded prospectively at the time of adnission to hospitals, and separate coronary prognostic indicesfor hospital and three-year survival had been formulated. The present follow-up shows that mortality between 3 and 6 years can still be related to factors dependent on the degree of myocardial damage sustained, and can be predicted by the coronary prognostic indexfor 3-year survival. Hypertension also had an adverse effect on survival, but the effect which emerges over the 3-to 6-year follow-up is apparent only in patients with an otherwise good prognosis.We have previously reported on clinical factors, present on admission to hospital, which were associated with mortality in a group of 757 patients with myocardial infarction admitted to three hospitals in Auckland during one year (I966-67) (Norris et al., i969, 1970). We incorporated numerical weightings for these factors into coronary prognostic indices for survival in hospital (Norris et al., i969), and for 3 years after discharge from hospital (Norris et al., I970). The present paper reports progress of the 3-year survivors of this same group of patients at a median period of 6 years after discharge. It shows that the chances of survival between 3 and 6 years after recovery were, as in our shorter term surveys, associated with age and factors dependent on the severity of myocardial damage. These factors were radiological evidence of pulmonary venous congestion, pulmonary oedema, and cardiac enlargement at the time of the infarct. vival was correlated with risk factors (hypertension, diabetes, and obesity), recorded at the time of infarction, and with the coronary prognostic index for 3-year survival. The diagnosis of hypertension was based either on a positive history from the patient or his referring practitioner, or the finding of high blood pressure requiring treatment during hospital admission.Of 530 patients followed after discharge from hospital (Norris et al., I970), 357 were known to be alive at 3 years. Of these, 349 (98%) were traced at 6 years, comprising 66 per cent of those who were originally discharged from the hospitals in I966-67.Results Seventy-eight patients had died between the 3-and 6-year follow-ups, this number being 22 per cent of the 357 three-year survivors, and I5 per cent of the original group of 530. Mortality at 3 years had been 33 per cent, so that the total 6-year mortality rate was 48 per cent of hospital survivors.Mortality rates were related to the presence of the previously described clinical prognostic factors which had been present at the time of infarction 6 years before.

Long-term prognosis after acute myocardial infarction in patients with a history of arterial hypertension

“…Hypertension is a risk factor among younger patients (risk ratio 1·4 in patients younger than 65), but not among older (risk ratio 1·0). The proportion of hypertensives in the present study population (23%) was comparable to that reported by others [3,4,[17][18][19][20] . The two groups differed considerably with regards to risk factors at baseline according to results of previous studies [4,11] .…”

Patient profile and follow‐up in medically and surgically treated elderly adults with myocardial infarction

“…The group of patients we present here differs from those of Norris et al (1974) and Kitchin and Milne (1977) in that we defined their coronary anatomy and ventricular function to correlate with their symptoms and function status. Surgery may have altered their prognosis.…”

“…The average mortality in patients less than 60-years-old was 12% and was noticeably higher in patients over 60, to the extent that it exceeded 50% in patients over age 80. In a group of 349 patients recovering from myocardial infarctions, Norris et al (1974) found that the mortality rate from 0-6 years post infarction was 67% for patients 70-79-years-old and 74% for those over 80. Kitchin and Milne (1977) found the five-year cardiac mortality in survivors of myocardial infarctions in patients over age 70 to be 40%.…”

Cancer chemotherapy--the inbuilt deterrent.

“…In systemic sclerosis early reports suggested that it was predominantly a disease of middle life and a comparative rarity in old age. [1][2][3] Before too long, however, the highest incidence was reported4 to be in patients aged over 65. This revised view was confirmed in a personal series of 15 cases seen by one physician in geriatric medicine in 11 years5-representing an incidence of about one per 1000 elderly patients admitted under his care.…”