Elsevier

American Heart Journal

Volume 162, Issue 3, September 2011, Pages 444-450
American Heart Journal

Clinical Investigation
Acute Ischemic Heart Disease
Trends in Q-wave acute myocardial infarction case fatality from 1978 to 2007 and analysis of the effectiveness of different treatments

https://doi.org/10.1016/j.ahj.2011.06.017Get rights and content

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.

Section snippets

Design

Since 1978, REgistre GIroni del COR, Girona Heart Registry (REGICOR) has been prospectively registering all first patients with AMI, residents of Girona aged 25 to 74 years, admitted to the area's sole tertiary referral hospital with a coronary care unit (CCU).18, 19 Six community hospitals refer these patients to this tertiary hospital after emergency treatment. This setting provides a population-based registry of hospitalized patients with AMI in a 591,060-km2 region of north-east Spain with

Results

Between 1978 and 2007, 3,849 consecutive patients aged 25 to 74 years with a first Q-wave AMI were prospectively admitted to the referral hospital. Study participant characteristics are shown in Table I. In this 30-year period, mean 28-day case fatality was 8.96% (95% confidence interval 8.09-9.92). Age, female sex, diabetes, hypertension, anterior location of AMI, previous angina, Killip classes III to IV, presence of severe arrhythmias, and reinfarction were associated with higher case

Discussion

In this 30-year prospective population-based hospital register, we observed a significant (70%) decrease in 28-day case fatality in patients with first Q-wave AMI, both in the first 24 hours and in the 24-hour to 28-day interval, over the study period. This decrease is mainly explained by the increasing use of effective pharmacologic treatments (explaining 51% of the decline) and also by the broad use of invasive procedures (explaining 38% of the decline).

A decrease in 28-day AMI case fatality

Conclusions

First Q-wave myocardial infarction case fatality has declined in the last 30 years by 70%. This decline is mainly explained by the use of pharmacologic treatment and the broad use of invasive treatment, which supports the current guidelines that recommend the use of invasive treatment after myocardial infarction for the management of acute coronary syndrome patients.

Acknowledgements

The authors appreciate the revision of the English text by Elaine Lilly, PhD (Writer's First Aid) and the contribution of Anna Puigdefábregas and Rosa Gispert from the Catalan Government Mortality Registry.

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