Summary
The purpose of this study was to describe the prognosis during 5 years of follow-up in a consecutive population of patients discharged from hospital after acute myocardial infarction (AMI) in relation to clinical history, level of initial care, complications during hospitalization, and medication at discharge. All patients admitted to a single hospital from February 15, 1986 to November 9, 1987 due to AMI, regardless of age and whether or not they were treated in the coronary care unit, and who were discharged alive from hospital were included in the study. There were 862 patients with AMI, 740 of whom were discharged alive. Information on medication at discharge was available in 713 patients (96%). In a multivariate analysis taking into account age, sex, history of cardiovascular diseases, whether patients were admitted to coronary care unit or not, complications during hospitalization, and medication at discharge, the following factors appeared to be independent predictors of mortality: age (p<0.001), history of AMI (p<0.001), congestive heart failure in hospital (p<0.001), whether beta-blockers had been prescribed at discharge (p<0.01), and a history of diabetes (p<0.01). This study indicates that in consecutive patients surviving the hospital phase of AMI, the development of complications while in hospital and the manner in which medication was prescribed at discharge independently influenced their longterm prognosis, but age was the most important factor in long-term prognosis.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
The Norwegian Multicenter Study Group. Timolol-induced reduction in mortality and reinfarction in patients surviving acute myocardial infarction. N Engl J Med 1981;304:801–807.
Beta-blocker Heart Attack Study Group: A randomized trial of propranolol in patients with acute myocardial infarction. JAMA 1982;247:1707.
Smith P, Arnesen H, Holme I. The effect of warfarin on mortality and reinfarction after myocardial infarction. N Engl J Med 1990;323:147–152.
ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction. Lancet 1988;2:349–360.
The MIAMI Trial Research Group. Metoprolol in acute myocardial infarction (MIAMI). A randomized placebocontrolled trial. Eur Heart J 1985;6:199–226.
ISIS-1 (First International Study of Infarct Survival) Collaborative Group. Randomised trial of intravenous atenolol among 16,027 cases of suspected acute myocardial infarction: ISIS-1. Lancet 1986;2:57–65.
Herlitz J, Karlson BW, Wiklund I, Bengtson A. Prognosis and gender differences in chest pain, patients discharged from an ED. Am J Emerg Med 1995;13:127–132.
Robinson K, Conroy RM, Mulcahy R. Risk factors and inhospital course of first myocardial infarction in the elderly. Clin Cardiol 1988;11:519–523.
Tofler GH, Muller JE, Stone PH, et al. Factors leading to shorter survival after acute myocardial infarction in patients ages 65 to 75 years compared with younger patients. Am J Cardiol 1988;62:860–867.
Herlitz J, Karlson BW, Hjalmarson Å. Prognosis of acute myocardial infarction in relation to age. Cardiol Elderly 1993;1:123–128.
Norris RM, Caughey DE, Mercer CJ, Deeming LW, Scott PJ. Coronary prognostic index for predicting survival after recovery from acute myocardial infarction. Lancet 1970;2:485–487.
Pohjola S, Siltanen P, Romo M. Five-year survival of 728 patients after myocardial infarction: A community study. Br Heart J 1980;43:176–183.
Epstein SE, Palmeri ST, Patterson RE. Evaluation of patients after myocardial infarction: Indications for cardiac catheterization and surgical intervention. N Engl J Med 1982;307:1487–1492.
Moss AJ, Benhorin J. Prognosis and management after a first myocardial infarction. N Engl J Med 1990;322:743–753.
Hjalmarson Å, Elmfeldt D, Herlitz J, et al. Effect on mortality of metoprolol in acute myocardial infarction. Lancet 1981;2:823–827.
Rytter L, Troelsen S, Beck-Nielsen H. Prevalence and mortality of acute myocardial infarction in patients with diabetes. Diabetes Care 1985;8:230–234.
Malmberg K, Rydén L. Myocardial infarction in patients with diabetes mellitus. Eur Heart J 1988;9:259–264.
Gwilt DJ, Petri M, Lewis PW, Nattrass M, Pentecost BL. Myocardial infarct size and mortality in diabetic patients. Br Heart J 1985;54:466–472.
Herlitz J, Malmberg K, Karlson BW, Ståhl L, Rydén L, Hjalmarson Å. Mortality and morbidity during a five-year follow-up in diabetics with myocardial infarction. Acta Med Scand 1988;224:31–38.
Bigger JT, Fleiss JL, Rolnitzky LM, Merab JP, Ferrick KJ. Effect of digitalis treatment on survival after acute myocardial infarction. Am J Cardiol 1985;55:623–630.
Madsen EB, Gilpin E, Henning H, et al. Prognostic importance of digitalis after acute myocardial infarction. J Am Card Cardiol 1984;3:681–689.
Karlson BW, Herlitz J, Wiklund O, Pettersson P, Hallgren P, Hjalmarson Å. Characteristics and prognosis of patients with acute myocardial infarction in relation to whether they were treated in the coronary care unit or in another ward. Cardiology 1992;81:134–144.
Karlson BW, Herlitz J, Edvardsson N, Emanuelsson H, Sjölin M, Hjalmarson Å. Eligibility for intravenous thrombolysis in suspected acute myocardial infarction. Circulation 1990;82:1140–1146.
Klein HH, Hengstenberg C, Peuckert M, Jurgensen R. Comparison of death rates from acute myocardial infarction in a single hospital in two different periods (1977–1978 versus 1988–1989). Am J Cardiol 1993;71:518–523.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Herlitz, J., Bång, A., Sjölin, M. et al. Five-year mortality after acute myocardial infarction in relation to previous history, level of initial care, complications in hospital, and medication at discharge. Cardiovasc Drug Ther 10, 485–490 (1996). https://doi.org/10.1007/BF00051115
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00051115