Importance of outside hospital mortality as a first acute ischemic heart event: the Quebec Cardiovascular Study
G R Dagenais1, B Cantin, F Dagenais
1Quebec Heart Institute, Ste-Foy, Lipid Research Centre, Laval University Hospital, Ste-Foy, Quebec.
Insights
Nearly one-third of men experiencing a first ischemic heart disease (IHD) event died, often outside the hospital. Established risk factors did not distinguish between fatal myocardial infarction (MI) and early IHD deaths.
Area of Science:
- Cardiology
- Epidemiology
- Public Health
Background:
- Ischemic heart disease (IHD) remains a leading cause of mortality worldwide.
- Understanding the patterns and risk factors of acute IHD events is crucial for public health interventions.
Purpose of the Study:
- To investigate the incidence, case fatality, and risk factors associated with acute ischemic heart disease (IHD) events in a cohort of men.
- To differentiate between fatal myocardial infarction (MI) and early deaths attributed to IHD.
Main Methods:
- A 16-year follow-up study of 4371 men aged 35-64, initially free of IHD.
- Analysis of acute IHD events, including nonfatal MI, fatal MI, and early deaths.
- Assessment of demographic factors and traditional cardiovascular risk factors (smoking, blood pressure, cholesterol).
Main Results:
- A first acute IHD event occurred in 426 men, with a 31% case fatality within four weeks.
- Early deaths accounted for a significant proportion of acute ischemic mortality (42% within 1 hour of symptom onset or found deceased).
- Smoking, elevated blood pressure, and serum cholesterol were associated with nonfatal events and all fatal events (except cholesterol for fatal MI).
Conclusions:
- A substantial proportion of men experiencing a first acute IHD event died, with a majority of these deaths occurring outside hospital settings.
- No significant differences in established risk factor profiles were found between men who died from fatal MI and those who experienced early IHD deaths.
- The findings highlight the importance of rapid response to acute IHD symptoms and underscore the limitations of current risk factor assessment in predicting sudden cardiac death.
Abstract:
Among 4371 men aged 35 to 64 in 1973 who were randomly selected, living in Quebec City suburbs, without clinical evidence of ischemic heart disease (IHD) at entry and followed for 16 years, 426 had a first acute IHD event; of these, 296 had a nonfatal myocardial infarction (MI), 50 a fatal MI (death within four weeks of the acute event) and 80 an early death, ie, they died before the diagnosis of MI was made. Among these 80 early deaths attributed to IHD in the absence of any other apparent cause, 55 men died within 1 h from the onset of symptoms or were found dead in their bed (group A) while 25 died more than 1 h after the onset of symptoms (group B). In this population, a first acute IHD event carried a 31% (130 of 426) case fatality within the first four weeks. Groups A and B accounted for 42% (55 of 130) and 19% (25 of 130) of the total acute ischemic mortality, respectively. As expected, fatal events increased with age, but the proportion of early deaths over the total IHD mortality was as frequent in younger men as in older men. Smoking, increased systolic and diastolic blood pressure and serum cholesterol were associated with increased nonfatal events. A similar association, except for serum cholesterol, was observed for all fatal events. No significant risk factor profile differentiated early from late fatal events. In conclusion, in this population, nearly a third of men with a first IHD event died, most of them outside the hospital. None of the main established risk factors differentiated men with a fatal MI from those with an early death.
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