Trends in Q-wave acute myocardial infarction case fatality from 1978 to 2007 and analysis of the effectiveness of different treatments

• Published in: The American heart journal 2011-09, Vol.162 (3), p.444-450
• Main Authors: Sala, Cristina, MD, Grau, Maria, MD, MPH, PhD, Masia, Rafel, MD, Vila, Joan, MSc, Subirana, Isaac, MSc, Ramos, Rafel, MD, PhD, Aboal, Jaime, MD, Sureda, Ariadna, MD, Brugada, Ramon, MD, PhD, Marrugat, Jaume, MD, PhD, Sala, Joan, MD, PhD, Elosua, Roberto, MD, PhD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Coronary heart disease; Electrocardiography; Fatalities; Female; Follow-Up Studies; Heart; Heart attacks; Hospital Mortality - trends; Hospital Records; Humans; Length of Stay - trends; Male; Medical sciences; Middle Aged; Mortality; Myocardial Infarction - diagnosis; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Myocardial Revascularization - methods; Myocarditis. Cardiomyopathies; Referral and Consultation; Retrospective Studies; Risk Assessment - methods; Severity of Illness Index; Spain - epidemiology; Survival Rate - trends; Trends
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2011.06.017

Background We sought to analyze the trends in first Q-wave acute myocardial infarction (AMI) case fatality from 1978 to 2007 in a population-based hospital register, to determine the variables related to these changes, and to assess the effectiveness of current AMI management. Methods Population-based hospital registry included patients with first Q-wave AMI aged 25 to 74 years admitted between 1978 and 2007. Sociodemographic and clinical characteristics, treatments, and procedures used during hospital stay, and 28-day case fatality were recorded. Logistic regression was used for multivariate analysis of six 5-year periods. Results The 30-year study included 3,982 patients. Mean 28-day case fatality was 8.96%, with a decreasing trend from 16.6% in the first 5-year period to 4.7% in the sixth (P for trend < .001). Study period was independently associated with case fatality. Case-fatality reduction attributable to pharmacologic treatments was 51% overall; in 24-hour survivors, pharmacologic treatments and broad use of invasive procedures explained 39% and 38%, respectively, of the difference between the observed case fatality in 2003-2007 and 1978-1982. Conclusion A dramatic decrease in 28-day case fatality occurred during this 30-year period and was mainly related to the use of antiplatelet drugs, β-blockers, thrombolysis, and invasive procedures. These data support the current guidelines for the management of acute coronary syndrome.