[Changes in hospital mortality from acute myocardial infarction during the last 15 years. The impact of reperfusion treatments].
OBJECTIVE
There are not any conclusive data about the changes in in-hospital mortality in a non-selected series of patients admitted with acute myocardial infarction in different periods of time. We studied the in-hospital mortality of three extensive series of patients admitted to our Coronary Care Unit during different periods of time, the influence of reperfusion methods and their early application, as well as the changes in baseline characteristics of the three populations studied.


METHODS
The in-hospital mortality of 1,858 consecutively-admitted patients during three different periods of time (1983-1986, 1992-1994, and 1995-1998) were studied. The demographic data, the previous history and risk factors, the evolution during the acute phase and the treatment prescribed with special attention to the reperfusion methods applied and the delay on its administration were compared.


RESULTS
The differences in the baseline characteristics of the populations studied are described. In the two groups of the nineteen-nineties, an increase in the age and in the percentage of women, diabetics and hypertensives was compared. As for the characteristics of acute myocardial infarction, an increase of patients in Killip class 3 and 4 stands out besides other changes. Fibrinolitic treatment decreased during the third period due to the increment in primary angioplasty. There were no significant differences in hospital mortality among the three series studied. The treatment with thrombolysis and primary angioplasty during the first two hours showed a significant independent reduction of mortality.


CONCLUSIONS
The early application of thrombolysis and primary angioplasty showed an independent reduction of the hospital mortality in our study. Nevertheless the non-adjusted mortality rate did not show any change during the last 15 years.
Echanove Errazti
I
I
Servicio de Cardiología (Unidad Coronaria), Hospital General Universitario de Valencia. ilechanove@jet.es
Velasco Rami
J A
JA
Ridocci Soriano
F
F
Pomar Domingo
F
F
Vilar Herrero
V
V
Martínez Alzamora
N
N
Payá Serrano
R
R
Carrión García
A
A
Atienza Fernández
F
F
Castelló Viguer
T
T
Esteban Esteban
E
E
Fabra Ortiz
C
C
Pérez Boscá
L
L
Peris Domingo
E
E
Rodríguez Hernández
J A
JA
D000368:Aged; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D015425:Myocardial Reperfusion; D013030:Spain / Q000453:epidemiology; D015912:Thrombolytic Therapy
Evolución de la mortalidad hospitalaria por infarto agudo de miocardio durante los últimos 15 años. Influencia de los tratamientos de reperfusión.