title: Trends in Q-wave acute myocardial infarction case fatality from 1978 to 2007 and analysis of the effectiveness of different treatments.
abstract: BACKGROUND
  We sought to analyze the trends in first Q-wave acute myocardial infarction (AMI) case fatality from 1978 to 2007 in a population-based hospital register, to determine the variables related to these changes, and to assess the effectiveness of current AMI management.
  
  
  METHODS
  Population-based hospital registry included patients with first Q-wave AMI aged 25 to 74 years admitted between 1978 and 2007. Sociodemographic and clinical characteristics, treatments, and procedures used during hospital stay, and 28-day case fatality were recorded. Logistic regression was used for multivariate analysis of six 5-year periods.
  
  
  RESULTS
  The 30-year study included 3,982 patients. Mean 28-day case fatality was 8.96%, with a decreasing trend from 16.6% in the first 5-year period to 4.7% in the sixth (P for trend < .001). Study period was independently associated with case fatality. Case-fatality reduction attributable to pharmacologic treatments was 51% overall; in 24-hour survivors, pharmacologic treatments and broad use of invasive procedures explained 39% and 38%, respectively, of the difference between the observed case fatality in 2003-2007 and 1978-1982.
  
  
  CONCLUSIONS
  A dramatic decrease in 28-day case fatality occurred during this 30-year period and was mainly related to the use of antiplatelet drugs, β-blockers, thrombolysis, and invasive procedures. These data support the current guidelines for the management of acute coronary syndrome.
authors: Centre Atenció Primaria Consell de Cent, Àmbit Barcelona Ciutat, Barcelona, Spain.
authors: Cristina
authors: C
authors: Sala
authors: Maria
authors: M
authors: Grau
authors: Rafel
authors: R
authors: Masia
authors: Joan
authors: J
authors: Vila
authors: Isaac
authors: I
authors: Subirana
authors: Rafel
authors: R
authors: Ramos
authors: Jaime
authors: J
authors: Aboal
authors: Ariadna
authors: A
authors: Sureda
authors: Ramon
authors: R
authors: Brugada
authors: Jaume
authors: J
authors: Marrugat
authors: Joan
authors: J
authors: Sala
authors: Roberto
authors: R
authors: Elosua
mesh_terms: D000328:Adult; D000368:Aged; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006753:Hospital Records; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D009204:Myocardial Revascularization / Q000379:methods*; D012017:Referral and Consultation; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends