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Prognostic importance of digitalis after acute myocardial infarction
Insights
Digitalis therapy after acute myocardial infarction (MI) was investigated. Despite higher mortality in patients taking digitalis, it was not an independent predictor of long-term mortality post-MI.
Area of Science:
- Cardiology
- Clinical Medicine
- Pharmacology
Background:
- Previous reports suggested digitalis may increase mortality post-acute myocardial infarction (MI).
- The independent prognostic value of digitalis therapy after MI requires further investigation.
Purpose of the Study:
- To investigate the independent importance of digitalis therapy in long-term prognosis after acute myocardial infarction.
Main Methods:
- Analysis of 1,599 patients post-definite myocardial infarction.
- Assessment of mortality rates at 4 months and 1 year post-hospital discharge.
- Multivariate Cox analysis to identify independent predictors of 1-year outcome.
Main Results:
- 36.6% of patients were taking digitalis at discharge.
- Digitalis users had more risk factors and higher mortality rates (12.5% at 4 months, 22.4% at 1 year) compared to non-users (5.0%, 9.6%).
- Multivariate analysis showed digitalis was not an independent predictor of 1-year mortality, unlike clinical variables such as age and congestive heart failure.
Conclusions:
- Digitalis therapy at discharge after myocardial infarction was not an independent predictor of late mortality.
- Clinical factors remain the primary determinants of long-term prognosis post-MI.
Abstract:
Because previous reports have suggested that digitalis administration may lead to increased mortality after hospital discharge for acute myocardial infarction, the independent importance of digitalis therapy in long-term prognosis after acute myocardial infarction was investigated by analyzing 1,599 patients after definite myocardial infarction. After hospital discharge, mortality rate for the entire group at 4 months was 7.7% and after 1 year 14.2%. At discharge, 36.6% of the patients were taking digitalis. Compared with those not taking digitalis, those taking digitalis had more historical risk factors and a higher incidence of important clinical prognostic variables during the hospitalization. Their cardiac mortality rate after 4 months and 1 year (12.5 and 22.4%, respectively) was significantly higher than that of patients not taking digitalis (5.0 and 9.6%, respectively). Mortality was higher for patients taking digitalis whether or not they had congestive heart failure during hospitalization. However, in a multivariate Cox analysis for 1 year outcome, neither digitalis nor any other medication variable displaced the important clinical variables of age, congestive heart failure during the hospitalization, previous myocardial infarction, maximal heart rate during the hospitalization and previous angina. Quinidine and digitalis at discharge were selected sixth and seventh (not significant) by the analysis. It is concluded that digitalis therapy at discharge after myocardial infarction was not an independent predictor of late mortality in these patients.