Hospital mortality of acute myocardial infarction in the thrombolytic era.
OBJECTIVE
To examine the management and outcome of an unselected consecutive series of patients admitted with acute myocardial infarction to a tertiary referral centre.


METHODS
A historical cohort study over a three year period (1992-94) of consecutive unselected admissions with acute myocardial infarction identified using the HIPE (hospital inpatient enquiry) database and validated according to MONICA criteria for definite or probable acute myocardial infarction.


METHODS
University teaching hospital and cardiac tertiary referral centre.


RESULTS
1059 patients were included. Mean age was 67 years; 60% were male and 40% female. Rates of coronary care unit (CCU) admission, thrombolysis, and predischarge angiography were 70%, 28%, and 32%, respectively. Overall in-hospital mortality was 18%. Independent predictors of hospital mortality by multivariate analysis were age, left ventricular failure, ventricular arrhythmias, cardiogenic shock, management outside CCU, and reinfarction. Hospital mortality in a small cohort from a non-tertiary referral centre was 14%, a difference largely explained by the lower mean age of these patients (64 years). Five year survival in the cohort was 50%. Only age and left ventricular failure were independent predictors of mortality at follow up.


CONCLUSIONS
In unselected consecutive patients the hospital mortality of acute myocardial infarction remains high (18%). Age and the occurrence of left ventricular failure are major determinants of short and long term mortality after acute myocardial infarction.
Mahon
N G
NG
Department of Clinical Cardiology, Epidemiology and Biostatistics, Mater Misericordiae Hospital, Eccles Street, Dublin 7, Republic of Ireland.
O'rorke
C
C
Codd
M B
MB
McCann
H A
HA
McGarry
K
K
Sugrue
D D
DD
D000367:Age Factors; D000368:Aged; D003325:Coronary Care Units / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D015996:Survival Rate; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications