Decreasing case fatality in myocardial infarction is explained by improved medical treatment

To access publisher full text version of this article. Please click on the hyperlink in Additional Links field OBJECTIVE: Treatment of ST-elevation myocardial infarction (STEMI) has changed significantly over the past two decades. We investigated the effect of these changes on one-year mortality. ME...

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Bibliographic Details
Main Authors: Andersen, Karl, Johannesdottir, Bergros Kristin, Kristjansson, Jon M, Gudnason, Thorarinn
Other Authors: University of Iceland, Faculty of Medicine, Reykjavik, Iceland. andersen@lsh.is
Format: Article in Journal/Newspaper
Language:English
Published: Acta Medica Belgica 2011
Subjects:
Aged
Female
Hospital Mortality
Humans
Iceland
Male
Middle Aged
Myocardial Infarction
Myocardial Reperfusion
Prognosis
Proportional Hazards Models
Risk Factors
Online Access:http://hdl.handle.net/2336/128653
https://doi.org/10.2143/AC.66.1.2064965
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Summary:To access publisher full text version of this article. Please click on the hyperlink in Additional Links field OBJECTIVE: Treatment of ST-elevation myocardial infarction (STEMI) has changed significantly over the past two decades. We investigated the effect of these changes on one-year mortality. METHODS AND RESULTS: All hospital admissions for STEMI in Reykjavik, Iceland, during the calendar years of 1986, 1996 and 2006 were studied. One-year mortality was related to changes in the use of reperfusion strategies and medication at hospital discharge. One-year mortality decreased from 26.3% in 1986 and 19.7% in 1996 to 12.9% in 2006 (P= 0.001). Cox proportional hazard analysis showed that aspirin (HR 0.29), the use of reperfusion therapy (HR 0.51) and beta-blockers at hospital discharge (HR 0.53) were the strongest factors to explain the mortality reduction while the use of diuretics (HR 1.42) and age (HR 1.06) were related to increased one-year mortality. CONCLUSIONS: The reduction in one-year mortality after myocardial infarction during the last two decades is explained by improved medical management with aspirin, beta-blockers and aggressive reperfusion therapy. Diuretic therapy, reflecting congestive heart failure, and increased age have negative effects on survival.

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