Modification of treatment strategies over a period of 14 years has markedly reduced cardiac events among post-myocardial infarction patients.
Recent trends in the treatment of post-myocardial infarction (MI) patients and the factors accounting for the improvement in outcome are presented. A total of 6,602 post-MI patients (5,320 males, 1,282 females; 58.9 +/- 10.4 years of age) enrolled between 1986 and 1999 were followed up for an average of 12.6 +/- 16.3 months. The incidence of cardiac events, which included fatal and nonfatal recurrent MIs, sudden death and death by congestive heart failure, was highest (44.9 events/1,000 person year) in 1986-1987, but decreased steadily to 22.5 events/1,000 person year by 1997-1999 (Trend p<0.0001). This trend accompanied the increased use of coronary thrombolysis, percutaneous transluminal coronary angioplasty and coronary artery bypass graft surgery, increased prescription of antiplatelet agents (51.5%-83.4%), lipid-lowering agents (29.8%-52.6%) and angiotensin-converting enzyme inhibitors (5.3%-->41.0%), and reduced prescription of calcium antagonists (68.5%-41.0%) and nitrates (60.7%-->45.7%). These changes in treatment have led to a decreased incidence of angina pectoris, wall motion abnormalities and abnormal Q waves on electrocardiograms. The decline in the incidence of cardiac events among post-MI patients in the 14 years between 1986 and 1999 reflects implementation of new therapeutic modalities proven to be effective in clinical trials and in daily practice.
Ishikawa
Kinji
K
ishikawa@med.kindai.ac.jp
Kimura
Akio
A
Taniwa
Takaaki
T
Takenaka
Toshihiko
T
Hayashi
Takahiro
T
Kanamasa
Ken
K
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data / Q000639:trends; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data / Q000639:trends; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data / Q000639:trends; D016896:Treatment Outcome
D000806:Angiotensin-Converting Enzyme Inhibitors; D000960:Hypolipidemic Agents; D010975:Platelet Aggregation Inhibitors