[In-hospital and long-term prognosis in acute myocardial infarction. Comparative longitudinal study of 2 patient groups]
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In-hospital mortality for acute myocardial infarction (AMI) significantly decreased between two patient groups. However, long-term survival rates remained unchanged, with recurrent myocardial infarction being the primary cause of death.
Area of Science:
- Cardiology
- Clinical Medicine
- Public Health
Background:
- Acute myocardial infarction (AMI) remains a leading cause of mortality worldwide.
- Comparing outcomes between different treatment eras is crucial for understanding advancements in cardiovascular care.
- Previous studies highlight variations in in-hospital and long-term prognosis for AMI patients.
Purpose of the Study:
- To compare in-hospital mortality, causes of death, and actuarial survival curves in two distinct patient cohorts admitted for AMI.
- To evaluate the impact of evolving diagnostic and management strategies on AMI patient outcomes over time.
- To assess long-term prognosis and identify primary causes of mortality in a non-surgically treated AMI population.
Main Methods:
- Retrospective analysis of two patient groups admitted to a coronary care unit (CCU) for AMI.
- Group A: 791 patients (September 1967–December 1972).
- Group B: 542 patients (January 1978–June 1980).
- Comparison of in-hospital mortality, specific causes of death (cardiogenic shock, pulmonary edema), and 54-month actuarial survival rates.
- Analysis of referral for coronary artery bypass grafting (CABG).
Main Results:
- In-hospital mortality significantly reduced in Group B (13.3%) compared to Group A (23.5%) (p<0.01).
- Deaths attributed to cardiogenic shock and pulmonary edema decreased significantly in Group B.
- No significant difference observed in long-term prognosis; actuarial survival curves overlapped after six months post-discharge.
- Recurrent myocardial infarction was the most frequent cause of death during follow-up.
Conclusions:
- Significant reduction in in-hospital mortality for acute myocardial infarction (AMI) observed, likely due to improved diagnosis and management.
- Long-term survival rates were not improved in this non-surgically treated AMI population.
- Further research is needed to enhance long-term outcomes for AMI survivors, particularly concerning recurrent events.
Abstract:
The in-hospital mortality, the causes of death, the actuarial survival curves were compared in two subsequent groups of patients admitted to our CCU for acute myocardial infarction: the first (group A) includes 791 pts, admitted from september '67 to december '72, the second (group B) includes 542 pts admitted from january '78 to june '80. The in-hospital mortality was significantly reduced in group B (A: 186/791, 23.5%; B: 72/542, 13,3%, p less than 0.01). This could be due to a reduction of the number of deaths for cardiogenic shock (A: 71/791, 9%; B: 30/542, 5.6%; p less than 0.01) and to reduction in the mortality rate for pulmonary oedema (from 6% to 1.5%, p less than 0.01), although the frequency of pulmonary oedema was the same during the two periods (A: 205 pts, 26%; B/156 pts 29%). We did not observe any significant difference in the long-term prognosis (54 months: A 79.3%, B 71.5%). The actuarial survival curves overlapped after the 1st semester after discharge. The most frequent cause of death during follow-up was a new myocardial infarction. None in the group A and only 3% in the group B were referred to the surgeon for coronary artery bypass grafting. We conclude that, in spite of a significant reduction of the in-hospital mortality, possibly related to the evolution in diagnosis and management of the disease, the long-term survival was not improved in a non-surgically treated population with myocardial infarction.