title: Decreasing case fatality in myocardial infarction is explained by improved medical treatment.
abstract: OBJECTIVE
  Treatment of ST-elevation myocardial infarction (STEMI) has changed significantly over the past two decades. We investigated the effect of these changes on one-year mortality.
  
  
  RESULTS
  All hospital admissions for STEMI in Reykjavik, Iceland, during the calendar years of 1986, 1996 and 2006 were studied. One-year mortality was related to changes in the use of reperfusion strategies and medication at hospital discharge. One-year mortality decreased from 26.3% in 1986 and 19.7% in 1996 to 12.9% in 2006 (P= 0.001). Cox proportional hazard analysis showed that aspirin (HR 0.29), the use of reperfusion therapy (HR 0.51) and beta-blockers at hospital discharge (HR 0.53) were the strongest factors to explain the mortality reduction while the use of diuretics (HR 1.42) and age (HR 1.06) were related to increased one-year mortality.
  
  
  CONCLUSIONS
  The reduction in one-year mortality after myocardial infarction during the last two decades is explained by improved medical management with aspirin, beta-blockers and aggressive reperfusion therapy. Diuretic therapy, reflecting congestive heart failure, and increased age have negative effects on survival.
authors: University of Iceland, Faculty of Medicine, Reykjavik, Iceland. andersen@lsh.is
authors: Karl
authors: K
authors: Andersen
authors: Bergrós Kristín
authors: BK
authors: Jóhannesdóttir
authors: Jón M
authors: JM
authors: Kristjánsson
authors: Thorarinn
authors: T
authors: Gudnason
mesh_terms: D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007055:Iceland / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000453:epidemiology* / Q000628:therapy*; D015425:Myocardial Reperfusion; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors