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Heart 1999;81:478-482; doi:10.1136/hrt.81.5.478
Copyright © 1999 BMJ Publishing Group Ltd & British Cardiovascular Society
Heart 1999;81:478-482 ( May )

Hospital mortality of acute myocardial infarction in the thrombolytic era

N G Mahon,a C O'Rorke,a M B Codd,a H A McCann,a K McGarry,b D D Sugruea

a Department of Clinical Cardiology, Epidemiology and Biostatistics, Mater Misericordiae Hospital, Eccles Street, Dublin 7, Republic of Ireland, b Department of Medicine, Our Lady's Hospital, Navan, Co Meath, Republic of Ireland

Correspondence to: Dr Sugrue.

Accepted for publication 1 December 1998

OBJECTIVE---To examine the management and outcome of an unselected consecutive series of patients admitted with acute myocardial infarction to a tertiary referral centre.
DESIGN---A historical cohort study over a three year period (1992-94) of consecutive unselected admissions with acute myocardial infarction identified using the HIPE (hospital inpatient enquiry) database and validated according to MONICA criteria for definite or probable acute myocardial infarction.
SETTING---University teaching hospital and cardiac tertiary referral centre.
RESULTS---1059 patients were included. Mean age was 67 years; 60% were male and 40% female. Rates of coronary care unit (CCU) admission, thrombolysis, and predischarge angiography were 70%, 28%, and 32%, respectively. Overall in-hospital mortality was 18%. Independent predictors of hospital mortality by multivariate analysis were age, left ventricular failure, ventricular arrhythmias, cardiogenic shock, management outside CCU, and reinfarction. Hospital mortality in a small cohort from a non-tertiary referral centre was 14%, a difference largely explained by the lower mean age of these patients (64 years). Five year survival in the cohort was 50%. Only age and left ventricular failure were independent predictors of mortality at follow up.
CONCLUSIONS---In unselected consecutive patients the hospital mortality of acute myocardial infarction remains high (18%). Age and the occurrence of left ventricular failure are major determinants of short and long term mortality after acute myocardial infarction.


Keywords: myocardial infarction; mortality; thrombolysis

© 1999 by Heart
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