Prognosis of acute myocardial infarction in the thrombolytic era: medical evaluation is still valuable.
BACKGROUND
Modern and sophisticated technology for the management of myocardial infarction has progressively devalued medical evaluation.


OBJECTIVE
This study was undertaken to assess the importance of the findings of medical evaluation at hospital presentation, in patients with acute myocardial infarction.


METHODS
Data from 590 thrombolytic-treated myocardial infarction patients were analyzed. The patients were grouped according to their clinical status on arrival at hospital. A modified Forrester classification--subset II was divided according to the absence (IIa) or presence (IIb) of symptoms--was applied. Short- (14 days) and long-term (up to 10 years) survival was analyzed and 19 independent variables were included in the multivariate models.


RESULTS
Short-term survival was 95.6% for subset I, 83.3% for subset IIa, 60% for subset IIb, 54.6% for subset III, and 34.8% for subset IV (P<0.001). By multiple regression analysis, lower clinical subsets (P<0.001), fewer coronary arteries with disease (P=0.006), younger age (P=0.014), absence of reinfarction (P=0.034), longer interval between streptokinase infusion and coronary arteriography (P=0.016), and higher left ventricular ejection fraction (P=0.037) demonstrated significant and independent correlation with short-term survival. Long-term survival for the total population was 71+/-3.6% for subset I, 54.4+/-8.5% for subset IIa, 20.8+/-9.4% for subset IIb, 54.5+/-15% for subset III, and 0% for subset IV (P<0.001). Using Cox regression analysis, lower clinical subsets (P<0.001), younger age (P<0.001), higher global left ventricular ejection fraction (P<0.001), and fewer coronary arteries with disease (P=0.021) correlated independently and significantly with long-term survival. When excluding data from patients who died before the short-term follow-up (n=532), lower clinical subsets remained an important predictor of long-term survival (P<0.001).


CONCLUSIONS
Clinical classification at hospital presentation is a powerful predictor of short- and long-term survival post-myocardial infarction.
Nicolau
J C
JC
Heart Institute (InCor), University of São Paulo Medical School, Rua Aureliano Coutinho 355-14o andar, São Paulo, SP 01224-020, Brazil. corjnicolau@incor.usp.br
Serrano
C V
CV
Garzon
S A
SA
Ramires
J A
JA
D017023:Coronary Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D011379:Prognosis; D015996:Survival Rate; D015912:Thrombolytic Therapy; D013997:Time Factors