Epidemiology of acute myocardial infarction with the emphasis on patients who did not reach the coronary care unit and non-AMI admissions.
OBJECTIVE
To describe the characteristics and outcome of patients with acute myocardial infarction (AMI) in a community, with particular emphasis on those who never reached a Coronary Care Unit (CCU) and those in whom the primary diagnosis was something other than a heart attack.


METHODS
Patients hospitalised in the city of Göteborg, Sweden, and discharged (dead or alive) with a diagnosis of AMI.


RESULTS
Among 1423 patient admissions the mean overall age was 75 years (81 years and 79 years in the two subsets). Among all patients, 33% had a history of heart failure and 20% had a history of cerebrovascular disease. The figures were even higher in the two subsets which were evaluated. In overall terms, an invasive strategy (coronary angiography) was used in 32% (in 5% and 9% in the two subsets respectively). The overall one-year and three-year mortality rate was 30% and 44% respectively. The three-year mortality rate among patients not admitted to a CCU was 65% and, among patients with no suspicion of a heart attack on admission, it was 68%.


CONCLUSIONS
Even in the 21st century, patients with AMI who reach hospital alive run a high risk of death and nearly half are dead within the first three years. In overall terms, patients are characterised by high age and high co-morbidity. Among patients who do not reach a CCU and among patients with no suspicion of AMI on admission, approximately two thirds are dead within the subsequent three years.
Herlitz
Johan
J
Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska, Göteborg, Sweden. johan.herlitz@hjl.gu.se
Dellborg
Mikael
M
Karlsson
Thomas
T
Evander
Maria Haglid
MH
Berger
Alan
A
Luepker
Russell
R
D000368:Aged; D000369:Aged, 80 and over; D003325:Coronary Care Units / Q000639:trends*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D010351:Patient Discharge / Q000639:trends; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome