[Long-term prognosis following a myocardial infarct: clinically prognostic variables and cardiovascular risk factors]

The long-term prognosis after myocardial infarction; clinical predictive variables and cardiovascular risk factors. In predicting long-term survival of 304 consecutive patients discharged after myocardial infarction between 1978 and 1981, and under 65 years of age, the significance of both hospital data and cardiovascular risk factors was examined. After discharge from hospital, the ten-year all-cause total mortality was 35.5%. Sudden death accounted for 42% of the recorded causes of death. The patients were not yet treated with thrombolysis at that time. After multivariate analysis, age, previous myocardial infarction, abnormal chest X-ray (increased cardiothoracic ratio or pulmonary congestion) and an increased cholesterol level were found to be independent and significant predictors of the ten-year mortality. Hypertension and gender were not associated with mortality. Patients with a previous myocardial infarction had, after adjustment for differences in age and other variables, a relative risk of dying within ten years of 1.70 (95% confidence interval 1.05-2.75) compared with those with a first infarction. A gradual increase of the ten-year mortality with elevated serum cholesterol level could be demonstrated (relative risk 1.14 per mmol/l, 95% CI 1.01-1.28). In conclusion, several routinely obtained parameters after myocardial infarction were related to subsequent long-term survival. Of the prognostic factors that may lead to useful therapeutic intervention after myocardial infarction, hypercholesterolaemia was most clearly associated with a reduced survival in the present study.