Extent of the decrease of 28-day case fatality of hospitalized patients with acute myocardial infarction over 22 years: epidemiological versus clinical view: the MONICA/KORA Augsburg infarction registry.
BACKGROUND
No data exist regarding time trends of 28-day case fatality (CF) of patients with presumed acute myocardial infarction (AMI) using epidemiological criteria, clinical criteria, and AMI classification after validation of presumed in-hospital AMI-related deaths (gold-standard criteria).


RESULTS
From 1985 to 2004, we prospectively examined all 9210 AMI patients consecutively hospitalized in a large teaching hospital by using a broad epidemiological AMI definition (WHO-MONICA). Twenty-eight-day CF decreased significantly from 32% in 1985-1986 to 18% in 2003-2004, mostly because of a reduction in early deaths (<24 hours). When applying the clinical AMI definition, most of the early deaths were not counted as AMI related. A retrospective validation process from a sample of all early deceased patients by the epidemiological AMI definition (388/2076) and a prospective validation of the complete cohort in 2005-2006 revealed that only about 50% of early deaths are reclassified as a real fatal AMI using newer criteria resulting in a 28-day CF of 23% in 1985-1986 and 11% in 2005-2006. The difference between the AMI 28-day CF by applying gold-standard criteria and the clinical AMI 28-day CF (18% in 1985-1986 and 7% in 2005-2006) has decreased during recent years.


CONCLUSIONS
The application of broad epidemiological criteria for AMI overestimates 28-day CF by almost 2-fold compared with gold-standard criteria (after validation of early deaths) and almost 3-fold compared to the clinical definition. The growing similarity in 28-day CF between the clinically based definition and the gold-standard criteria implies that recent clinical-based registries may represent a realistic picture of trends regarding in-hospital AMI mortality.
Kuch
Bernhard
B
I. Medizinische Klinik, Klinikum Augsburg, teaching hospital of Ludwig Maximilians University München, Augsburg, Germany. bernhard.kuch@klinikum-augsburg.de
von Scheidt
Wolfgang
W
Ehmann
Anja
A
Kling
Birgitt
B
Greschik
Claudia
C
Hoermann
Allmut
A
Meisinger
Christa
C
D000328:Adult; D000368:Aged; D003953:Diagnosis-Related Groups / Q000145:classification / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D005858:Germany / Q000453:epidemiology; D017052:Hospital Mortality / Q000639:trends*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000145:classification* / Q000175:diagnosis / Q000401:mortality*; D011379:Prognosis; D012042:Registries / Q000592:standards* / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012189:Retrospective Studies