Clinical Investigations: Acute Ischemic Heart Disease
Prognosis after acute myocardial infarction continues to improve in the reperfusion era in the community of Göteborg*,**,

https://doi.org/10.1067/mhj.2002.123312Get rights and content

Abstract

Background The objective of this study was to compare the prognosis of nonselected patients who had an acute myocardial infarction (AMI) during 2 time periods in the thrombolytic era and to describe coronary heart disease (CHD) mortality rates in the community of Göteborg during 1990 to 1995. Methods Patients aged <75 years who were hospitalized in the community of Göteborg for AMI during 1990 to 1991 (period 1) and 1995 to 1996 (period 2) were compared in terms of history, treatment for AMI, and outcome. Information on CHD mortality rates in the community of Göteborg was gathered from the National Registry of Deaths. Results The numbers of patients in the 2 cohorts were 926 and 861, respectively. The incidence rate for AMI per 100,000 inhabitants and year was 200 for period 1 and 183 during period 2. During period 2, there was an increased use of percutaneous transluminal coronary angioplasty, coronary artery bypass grafting, angiotensin-converting enzyme inhibitors, heparin, and intravenous nitroglycerin. On the other hand, there was a decreased use of thrombolytic agents, diuretic agents, digitalis, long-acting nitrates, calcium-channel blockers, and lidocaine. The hospital case-fatality rates were 9.4% during period 1 and 6.0% during period 2 (P =.01). The adjusted risk ratio for period 2 versus period 1 was 0.65, with 95% confidence limits of 0.45 to 0.94. The mortality rate over a period of 3 years was 26.5% during period 1 and 17.8% during period 2 (P <.0001). The adjusted risk ratio for period 2 versus period 1 was 0.67, with 95% confidence limits of 0.54 to 0.82. Among inhabitants aged 30 to 74 years in the community of Göteborg, the CHD mortality rate decreased in 1995 as compared with 1990 (age-adjusted odds ratio 0.79, 95% confidence limits 0.68 to 0.92). Conclusions For consecutive patients aged <75 years who were hospitalized for AMI in the community of Göteborg, we found that in the thrombolytic era, major changes in medical and nonmedical treatment still took place associated with a continuing decrease in mortality rates during 3 years of follow-up. A similar reduction of CHD mortality rates was seen in the same age group within the community of Göteborg. (Am Heart J 2002;144:89-94.)

Section snippets

Period 1

All patients hospitalized for AMI at the 2 city hospitals (Sahlgrenska and Östra Hospitals) in Göteborg between January 1, 1990, and December 31, 1991, were aged <75 years and living in the community of Göteborg. There are no private hospitals or other hospitals in the community. There are 2 hospitals outside the community 10 and 20 kilometers from the 2 community hospitals. However, patients in the community of Göteborg were not admitted to these hospitals.

Period 2

All patients hospitalized for AMI at

Results

In all, there were 926 patients registered during period 1 and 861 during period 2. The incidence rate for AMI per 100,000 inhabitants and year was 200 for period 1 and 183 for period 2. The proportion of patients admitted to the CCU was 91% during period 1 and 96% during period 2 (P =.0002).

Discusson

During the last decade, many surveys have compared the outcome of patients with AMI before and after the introduction of thrombolysis (prethrombolytic and postthrombolytic eras).10, 13, 19 A reduction in mortality rate was observed, although it has been clearly stated that the reduced mortality rate might be attributable to factors other than the introduction of thrombolysis.2, 19

However, few studies have been from the more generalizable perspective of a total community.

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    *

    Supported by grants from the Swedish Heart and Lung Foundation, Stockholm, the Gothenburg Medical Society, Göteborg, and The Association of Local Authorities in Western Götaland, Sweden.

    **

    Reprint requests: Johan Herlitz, MD, PhD, Division of Cardiology, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden.

    E-mail: [email protected]

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