Long-term mortality after first Acute Myocardial Infarction in the light of changing therapeutic guidelines and diagnostic criteria between 1995 and 2003
Beschreibung
vor 14 Jahren
Background: The introduction of new invasive therapies for acute
myocardial infarction and new medication schemes for secondary
prevention is thought to increase life expectancy in 28-day
survivors of a first myocardial infarction. The present study
examined mortality and re-infarction rate of those patients in the
light of changed therapeutic guidelines. Methods: Cases of 25 to 74
year old 28-day survivors of a first definite AMI based on MONICA
criteria were identified in the Coronary Event Registry in
Augsburg, Southern Germany, who had their index event between the
1st of January 1995 and the 31st of December 2003. Mortality and
re-infarction rates were calculated for 1 year, 3 years and total
follow-up. Cox models were built to compare the rates of persons,
who suffered the index event between 1995 and 1999 (Study period 1)
with those who had their first AMI between 2000 and 2003 (Study
period 2). Results: Crude mortality was higher in Study period 1
than in Study period 2 and higher for women than for men.
Re-infarction rates remained stable for men during both study
periods, but women from Study period 1 had a much higher
re-infarction rate than women in Study period 2. The hazard ratios
showed no significant differences for mortality and re-infarction
in men. Hazard ratios of re-infarction in women were significantly
reduced, but have to be treated with caution as the number of
re-infarctions during Study period 2 was very small. Mortality
hazard ratios in women were also not significant. Conclusions: When
comparing the time periods before and after the introduction of new
therapeutic guidelines, an effect on mortality or re-infarction
rate cannot be established. Several reasons are probably
responsible for this finding. The population of patients has
changed with respect to their risk factors and new diagnostic
criteria may have also contributed. Further studies are needed to
illuminate these questions.
myocardial infarction and new medication schemes for secondary
prevention is thought to increase life expectancy in 28-day
survivors of a first myocardial infarction. The present study
examined mortality and re-infarction rate of those patients in the
light of changed therapeutic guidelines. Methods: Cases of 25 to 74
year old 28-day survivors of a first definite AMI based on MONICA
criteria were identified in the Coronary Event Registry in
Augsburg, Southern Germany, who had their index event between the
1st of January 1995 and the 31st of December 2003. Mortality and
re-infarction rates were calculated for 1 year, 3 years and total
follow-up. Cox models were built to compare the rates of persons,
who suffered the index event between 1995 and 1999 (Study period 1)
with those who had their first AMI between 2000 and 2003 (Study
period 2). Results: Crude mortality was higher in Study period 1
than in Study period 2 and higher for women than for men.
Re-infarction rates remained stable for men during both study
periods, but women from Study period 1 had a much higher
re-infarction rate than women in Study period 2. The hazard ratios
showed no significant differences for mortality and re-infarction
in men. Hazard ratios of re-infarction in women were significantly
reduced, but have to be treated with caution as the number of
re-infarctions during Study period 2 was very small. Mortality
hazard ratios in women were also not significant. Conclusions: When
comparing the time periods before and after the introduction of new
therapeutic guidelines, an effect on mortality or re-infarction
rate cannot be established. Several reasons are probably
responsible for this finding. The population of patients has
changed with respect to their risk factors and new diagnostic
criteria may have also contributed. Further studies are needed to
illuminate these questions.
Weitere Episoden
Kommentare (0)