Objectives.
This study sought to evaluate the in-hospital and postdischarge mortality of patients with an acute myocardial infarction in the 1990s.
Background.
The widespread implementation of therapeutic interventions that modify the natural history of coronary artery disease has led to changes in the profile and survival of patients with an acute myocardial infarction. Although data exist for selected subsets of patients with an acute myocardial infarction, at this time there is little recent prospective information on all patients presenting with an acute myocardial infarction, particularly for survival after hospital discharge.
Methods.
All patients ≤75 years old presenting with an acute myocardial infarction between July 1, 1990 and June 30, 1992 at nine Canadian hospitals were prospectively evaluated and followed up for 1 year. From November 1991, patients of all ages were included. In two centers, recruitment continued until December 31, 1992. A total of 3,178 patients were recruited.
Results.
The in-hospital mortality rate of patients ≤75 years old was 8.4%, and that at 1 year after hospital discharge was 5.3%. For patients of all ages recruited after November 1, 1991, the in-hospital mortality rate was 9.9% and 7.1% for 1 year after hospital discharge. For patients ≤75 years old, age carried an independent in-hospital but no postdischarge risk. Female patients had a twofold greater risk of dying in hospital. After hospital discharge, only 1.7% of patients ≤75 years old and 1.9% of patients of all ages died of a presumed arrhythmic death. Premature ventricular contractions had no independent prognostic value. The relatively low in-hospital (5.3%) and postdischarge (6.1%) reinfarction rate may have contributed to improved survival. A greater reinfarction rate in patients ≥ 75 years old (17.4% vs. 9.6%, p < 0.001) may have contributed to their poorer outcome.
Conclusions.
One-year mortality after acute myocardial infarction continues to decrease, and changes in the prognostic value of traditional methods of risk stratification have occurred.