Clinical InvestigationAcute Ischemic Heart DiseaseTrends in Q-wave acute myocardial infarction case fatality from 1978 to 2007 and analysis of the effectiveness of different treatments
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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- 1
On behalf of the REGICOR investigators.