Small differences in non-fatal in-hospital reinfarctions complicating acute myocardial infarction as observed in current randomised controlled trials will not essentially influence long-term mortality. Results from the Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) Registry.
BACKGROUND
Recent randomized controlled trials (RCT) comparing different nonmechanical reperfusion strategies in patients with acute ST elevation myocardial infarction (AMI) (The GUSTO V, the ASSENT 3 and the HERO 2 trials) reported no differences in mortality, but lower nonfatal reinfarction rates in each best treatment arm during the hospital stay.


METHODS
We analyzed the prospective observational Maximal Individual The rapy in Acute Myocardial Infarction (MITRA) data base selecting AMI patients similar to the RCT patients, to determine whether the observed differences in reinfarction rates will have an influence on longterm mortality.


RESULTS
Out of 6737 patients included in MITRA between 1994 and 2000, 2109 (31%) fulfilled the selection criteria simulating the RCTs and were followed up for a median of 18 (quartiles: 16/22) months. Mortality at 1-year after discharge was 6.8% (95%CI: 2.3-11.3%) in patients with versus 4.4% (95%CI: 3.5-5.3%) in patients without a non-fatal reinfarction (absolute difference 2.4%, p = 0.04 by log rank test). Transferred to the results of the RCTs, this difference would require more than 1 million patients in each treatment arm of the RCTs to show significant differences in long-term mortality.


CONCLUSIONS
Non-fatal in-hospital reinfarctions were associated with a higher mortality during the 18 month follow-up in MITRA. However, because the observed differences in the rates of non-fatal in hospital reinfarctions between the treatment arms in the GUSTO V, the ASSENT 3 and the HERO 2 trials were very small, our data make it very improbable that they will result in lower 1-year mortality rates.
Herzzentrum Ludwigshafen, Kardiologie, Bremserstrasse 79, 67063 Ludwigshafen, Germany. erzahn@aol.com
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Schneider
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D000368:Aged; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D010343:Patient Admission / Q000706:statistics & numerical data*; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D013300:Streptokinase / Q000627:therapeutic use; D016019:Survival Analysis; D015912:Thrombolytic Therapy / Q000401:mortality; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
D013300:Streptokinase; D010959:Tissue Plasminogen Activator