[Reduction in acute myocardial infarction mortality over a five-year period].
OBJECTIVE
To assess recent changes in the management of patients with acute myocardial infarction (AMI) and their impact on mortality using data from the PRIAMHO I and II registries (1995 and 2000).


METHODS
Of the 168 public hospitals in Spain, 24 and 58 contributed to the 1995 and 2000 PRIAMHO registries, respectively.


RESULTS
Patients in the PRIAMHO II registry (n=6221) were significantly older, more often female, and proportionally more likely to have coronary risk factors or a previous myocardial infarction, or to have undergone revascularization than those in PRIAMHO I (n=5242). Reperfusion therapy was administered more often (46.9% vs 41.9%, P<.001) and earlier (48 min vs 60 min, P<.001). Antiplatelet drugs were given to 96.1% vs 89.1% of patients, beta-blockers to 51.1% vs 30.1%, and ACE inhibitors to 41.6% vs 24.9% (P<.001 for all comparisons). In addition, 28-day mortality was 11.3% and 14.2% (P<.001), respectively, and one-year mortality, 16.4% and 18.5% (P<.001), respectively. The adjusted hazard ratio for mortality at one year in PRIAMHO II compared with PRIAMHO I was 0.78 (95% CI, 0.70-0.86, P<.001; adjusted for age, sex, diabetes, smoking, dyslipemia, hypertension, previous MI and CABG, ST-elevation status and Killip class at admission, and hospital characteristics).


CONCLUSIONS
Even though patients registered in 2000 formed a higher risk group than those registered in 1995, one-year mortality after AMI decreased by 22% over the five-year period. This improvement was due to more frequent and earlier reperfusion therapy and better use of antithrombotics, beta-blockers and ACE inhibitors.
Heras
Magda
M
Servicio de Cardiología, Hospital Clínic, Barcelona, España. mheras@clinic.ub.es
Marrugat
Jaume
J
Arós
Fernando
F
Bosch
Xavier
X
Enero
José
J
Suárez
Miguel A
MA
Pabón
Pedro
P
Ancillo
Pablo
P
Loma-Osorio
Angel
A
Rodríguez
Juan J
JJ
Subirana
Isaac
I
Vila
Joan
J
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000367:Age Factors; D015906:Angioplasty, Balloon, Coronary; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D003627:Data Interpretation, Statistical; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality* / Q000628:therapy; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011379:Prognosis; D012008:Recurrence; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors; D013030:Spain; D016019:Survival Analysis; D013997:Time Factors
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D010975:Platelet Aggregation Inhibitors