title: Trends in in-hospital mortality and six-month outcomes in patients with a first acute myocardial infarction. Change over the last decade.
abstract: OBJECTIVE
  Treatment of acute myocardial infarction (AMI) has changed considerably in recent years. The objective of this study was to investigate differences in in-hospital mortality and 6-month outcomes after a first AMI between patients who participated in two trials, in 1992-1994 and 2001-2003, respectively.
  
  
  METHODS
  The study involved 1440 consecutive patients with a first AMI who were admitted to four university hospitals during 1992-1994 (the RESCATE-I trial) and 1288 with a first AMI who met the same diagnostic criteria and who were admitted to the same hospitals during 2001-2003 (the RESCATE-II trial). Patient management, in-hospital mortality and 6-month prognosis and outcomes were compared between the two trials.
  
  
  RESULTS
  Reperfusion therapy was carried out in 60.7% of patients in the first trial and in 72.6% in the second (P< .001). In the RESCATE-II trial, the median door-to-needle time was shorter (41 min vs. 93 min; P< .001) and patients more frequently underwent coronary angiography (65.2% vs. 28.1%; P< .001) and revascularization (34.9% vs. 8.1%; P< .001). In addition, in-hospital mortality was lower in RESCATE-II (7.5% vs. 10.9%; P< .001). After adjustment for age, sex, comorbidity, AMI severity and reperfusion therapy, the odds ratio for in-hospital mortality in RESCATE-II compared with the first trial was 0.52 (95% confidence interval, 0.31-0.86). In addition, mortality (1.4% vs. 3.6%; P=.001) and readmissions at 6 months were also lower in RESCATE-II.
  
  
  CONCLUSIONS
  Both in-hospital and 6-month mortality in patients with a first AMI decreased during the last decade, probably due to more frequent reperfusion and revascularization therapy and better medical treatment.
authors.affiliation: Servicio de Cardiología, Hospital del Mar, Barcelona, España. CGarciaG@imas.imim.es
authors.forename: Cosme
authors.initials: C
authors.lastname: García-García
authors.forename: Gines
authors.initials: G
authors.lastname: Sanz
authors.forename: Vicente
authors.initials: V
authors.lastname: Valle
authors.forename: Lluís
authors.initials: L
authors.lastname: Molina
authors.forename: Joan
authors.initials: J
authors.lastname: Sala
authors.forename: Isaac
authors.initials: I
authors.lastname: Subirana
authors.forename: Helena
authors.initials: H
authors.lastname: Martí
authors.forename: Jaume
authors.initials: J
authors.lastname: Marrugat
authors.forename: Jordi
authors.initials: J
authors.lastname: Bruguera
authors.forename: Rafel
authors.initials: R
authors.lastname: Masià
authors.forename: Roberto
authors.initials: R
authors.lastname: Elosua
mesh_terms: D000208:Acute Disease; D000368:Aged; D017023:Coronary Angiography; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D015425:Myocardial Reperfusion; D011379:Prognosis; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis; D016896:Treatment Outcome