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Prognosis after initial myocardial infarction: the Framingham study
Insights
Men and women experiencing myocardial infarction face significant long-term risks. Women have a worse prognosis after myocardial infarction, with higher early mortality and reinfarction rates than men.
Area of Science:
- Cardiology
- Epidemiology
- Public Health
Background:
- Coronary heart disease (CHD) remains a leading cause of mortality.
- Understanding the long-term prognosis after myocardial infarction (MI) is crucial for patient management and public health strategies.
Purpose of the Study:
- To investigate the long-term mortality and morbidity following recognized and unrecognized myocardial infarctions in a large cohort.
- To compare the prognosis of myocardial infarction between men and women.
Main Methods:
- Prospective cohort study of 5,127 initially CHD-free individuals from the Framingham cohort.
- Follow-up over 20 years to ascertain myocardial infarctions, subsequent mortality, and morbidity (angina, reinfarction, congestive heart failure, sudden death).
Main Results:
- One in five men with a first MI died within 1 year; mortality was 14 times higher than in those without CHD.
- In men surviving the first year, 5-year mortality risk was four times that of the general population.
- Women experienced higher early mortality and were more prone to reinfarction (40% within 5 years) compared to men (13%).
- Congestive heart failure affected 14% of men within 5 years, with a 50% mortality rate once it ensued.
Conclusions:
- Myocardial infarction significantly increases long-term mortality and morbidity risk for both men and women.
- Women face a distinctly worse prognosis after myocardial infarction compared to men, particularly regarding early mortality and reinfarction.
- Recognized and unrecognized myocardial infarctions have similar long-term survival rates, highlighting the importance of identifying all MIs.
Abstract:
During 20 years of follow-up of 5,127 men and women initially free of coronary heart disease in the Framingham cohort, 193 men and 53 women had one or more recognized, symptomatic myocardial infarctions. An additional 45 men and 28 women had unrecognized myocardial infarctions. Subsequent mortality and morbidity including angina, reinfarction, congestive failure and sudden death were ascertained. One in five men who had a first myocardial infarction died within 1 year, a mortality rate 14 times that of those free of coronary heart disease. In men who survived the 1st year, a recognized myocardial infarction increased risk of death over the next 5 years to 23 percent, four times that of the general population. The next 5 years carried a 25 percent mortality (three times that of the general population). The prognosis was distinctly worse in women than in men chiefly because of a higher (45 percent) early mortality rate in women. Patients with recognized and unrecognized myocardial infarctions had similar survival rates after 3 years. A second myocardial infarction occurred in 13 percent of the men and in 40 percent of the women within 5 years of the first infarction. Thus, women were more prone to death and reinfarction than men. Congestive heart failure occurred as commonly as reinfarction, affliction 14 percent of the men within 5 years of the initial infarction. Once congestive failure ensued, half of the affected patients were dead within 5 years. Angina developed in one third of the patients within 5 years of their first infarction.