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Published on: November 26, 2013
Hospital mortality of acute myocardial infarction in the thrombolytic era
N G Mahon1, C O'rorke, M B Codd
1Department of Clinical Cardiology, Epidemiology and Biostatistics, Mater Misericordiae Hospital, Eccles Street, Dublin 7, Republic of Ireland.
Insights
Hospital mortality for acute myocardial infarction remains high at 18%. Key predictors of mortality include patient age and left ventricular failure, impacting both short and long-term outcomes.
Area of Science:
- Cardiology
- Clinical Medicine
- Epidemiology
Background:
- Acute myocardial infarction (AMI) management and outcomes in tertiary referral centers require ongoing evaluation.
- Understanding patient demographics and treatment patterns is crucial for improving AMI care.
Purpose of the Study:
- To assess the management strategies and patient outcomes for consecutive admissions with acute myocardial infarction.
- To identify predictors of in-hospital and long-term mortality following AMI.
Main Methods:
- A historical cohort study analyzed 1059 unselected AMI admissions between 1992-1994.
- Data were sourced from the HIPE (hospital inpatient enquiry) database and validated using MONICA criteria.
- Multivariate analysis identified independent predictors of mortality.
Main Results:
- The overall in-hospital mortality rate was 18%, with higher rates in older patients and those with left ventricular failure.
- Coronary care unit (CCU) admission, thrombolysis, and angiography rates were 70%, 28%, and 32%, respectively.
- Five-year survival was 50%, with age and left ventricular failure being significant predictors.
Conclusions:
- Acute myocardial infarction continues to have a high in-hospital mortality rate.
- Patient age and the presence of left ventricular failure are critical determinants of both short-term and long-term survival after AMI.
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 in-hospital 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 difference 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.
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