Overview of trends in heart disease. Changing prognosis after myocardial infarction.
The improved survival of patients with coronary heart disease during the past 30 years has resulted in a large elderly patient population who likely are at greater risk for developing cerebrovascular disease. In the 1960s, the total in-hospital mortality for patients with acute myocardial infarction under 70 years old was reduced from about 22 to 17% by the widespread use of coronary care units with a reduction in "arrhythmic" deaths. During the 1970s, the development of the flow-directed catheter and the use of interventions to reduce the extent of infarction decreased the short-term mortality rate to about 13%. More recently, thrombolytic therapy has resulted in an early in-hospital mortality rate as low as 4 to 6%. Predischarge noninvasive risk stratification of uncomplicated patients leads to selective coronary arteriography and the early initiation of appropriate surgical, mechanical, or medical treatment. Improved long-term survival results partly from better in-hospital therapy and predischarge risk stratification as well as from secondary prevention.
O'Rourke
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University of Texas Health Science Center at San Antonio 78284-7872.
D000368:Aged; D017052:Hospital Mortality; D006801:Humans; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends