Improved long term prognosis after myocardial infarction 1984-1991

Abstract

Aims. We set out to examine whether long term prognosis in terms of 2-year mortality after myocardial infarction has improved after the introduction of intravenous betablockers, nitroglycerin infusion, aspirin and thrombolytics, in an unselected population of patients hospitalized with a myocardial infarction. Methods and Results. We investigated retrospectively 3791 acute myocardial infarctions in 3187 Goteborg women and men (1039 women and 2148 men), who were consecutively admitted to the coronary care unit at the Ostra hospital during 1984-1991. Throughout this period, data were entered continuously into the coronary care unit database. Mortality data were collected through the Swedish cause-specific mortality register. The primary endpoint was mortality within 2 years after the onset of the index infarction. Two-year mortality decreased from 36% in 1984 to 25% in 1991. In a Cox regression model (including myocardial infarctions up to 1993) year of hospitalization, age, diabetes mellitus, sex, prior myocardial infarction and indeterminable infarct location all had a significant impact on survival after myocardial infarct. Thrombolytic therapy and hypertension had no prognostic significance. Conclusion. Against a background of radical changes in the treatment of acute myocardial infarction during 1984-1991 we have seen decreasing in-hospital mortality as well as a substantial decrease in 2-year mortality.