title: Changes in clinical profile, treatment, and mortality in patients hospitalised for acute myocardial infarction between 1985 and 2008.
abstract: OBJECTIVE
  To quantify the impact of the implementation of treatment modalities into clinical practice since 1985, on outcome of patients with ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI).
  
  
  METHODS
  All consecutive patients admitted for STEMI or NSTEMI at the Thoraxcenter between 1985 and 2008 were included. Baseline characteristics, pharmacological and invasive treatment modalities, and survival status were collected. The study population was categorised in three groups of patients: those hospitalised between 1985-1990, 1990-2000, and 2000-2008.
  
  
  RESULTS
  We identified 14,434 patients hospitalised for myocardial infarction (MI). Both STEMI and NSTEMI patients were increasingly treated with the current guideline based therapy. In STEMI, at 30 days following admission, cumulative mortality rate decreased from 17% in 1985-1990 to 13% in 1990-2000, and to 6% in 2000-2008. Adjusted 30-day and three-year mortality in the last period was 80% and 68% lower than in 1985, respectively. In NSTEMI, at 30 days following admission, cumulative mortality rate decreased from 6% in 1985-1990 to 4% in 1990-2000, and to 2% in 2000-2008. Adjusted 30-day and three-year mortality in the last period was 78% and 49% lower than in 1985, respectively. For patients admitted between 2000 and 2008, 3 year survival of STEMI and NSTEMI patients was 87% and 88%, respectively.
  
  
  CONCLUSIONS
  Our results indicate substantial improvements in acute- and long-term survival in patients hospitalised for MI, related to improved acute- as well as long-term treatment. Early medical evaluation in suspected MI and intensive early hospital treatment both remain warranted in the future.
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Sjoerd T
authors.initials: ST
authors.lastname: Nauta
authors.forename: Jaap W
authors.initials: JW
authors.lastname: Deckers
authors.forename: Martijn
authors.initials: M
authors.lastname: Akkerhuis
authors.forename: Mattie
authors.initials: M
authors.lastname: Lenzen
authors.forename: Maarten L
authors.initials: ML
authors.lastname: Simoons
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D011446:Prospective Studies
references.citation: Am J Med. 2011 Jan;124(1):40-7
references.pmid: 21187184
references.citation: JAMA. 2011 Apr 27;305(16):1677-84
references.pmid: 21521849
references.citation: Lancet. 2009 Mar 14;373(9667):929-40
references.pmid: 19286092
references.citation: Eur Heart J. 1997 Jan;18(1):41-51
references.pmid: 9049514
references.citation: Circulation. 2001 Jul 3;104(1):19-24
references.pmid: 11435332
references.citation: Circulation. 1996 Nov 15;94(10):2441-6
references.pmid: 8921786
references.citation: Circulation. 2000 Jun 6;101(22):2557-67
references.pmid: 10840005
references.citation: N Engl J Med. 1993 Sep 2;329(10):673-82
references.pmid: 8204123
references.citation: N Engl J Med. 2010 Jun 10;362(23):2155-65
references.pmid: 20558366
references.citation: Eur Heart J. 2008 Dec;29(23):2909-45
references.pmid: 19004841
references.citation: N Engl J Med. 1999 Dec 23;341(26):1949-56
references.pmid: 10607811
references.citation: Heart. 2010 Aug;96(15):1201-6
references.pmid: 20530127
references.citation: Circ Cardiovasc Qual Outcomes. 2010 Nov;3(6):581-9
references.pmid: 20923995
references.citation: Circulation. 2006 Dec 19;114(25):2806-14
references.pmid: 17145994
references.citation: Circ Cardiovasc Qual Outcomes. 2009 Mar;2(2):88-95
references.pmid: 20031820
references.citation: Lancet. 2007 Mar 10;369(9564):827-835
references.pmid: 17350451
references.citation: Eur Heart J. 1996 Jan;17(1):89-95
references.pmid: 8682136
references.citation: Lancet. 2006 Sep 16;368(9540):998-1004
references.pmid: 16980115
references.citation: Lancet. 1985 Sep 14;2(8455):578-82
references.pmid: 2863596
references.citation: Lancet. 1993 Dec 18-25;342(8886-8887):1523-8
references.pmid: 7902905
references.citation: BMJ. 2009 Jun 30;338:b2376
references.pmid: 19567909
references.citation: JAMA. 2000 Aug 16;284(7):835-42
references.pmid: 10938172
references.citation: Eur Heart J. 1995 Mar;16(3):325-32
references.pmid: 7789374
references.citation: JAMA. 2007 May 2;297(17):1892-900
references.pmid: 17473299
references.citation: BMJ. 2002 Jan 12;324(7329):71-86
references.pmid: 11786451
references.citation: N Engl J Med. 1999 Nov 4;341(19):1413-9
references.pmid: 10547403
references.citation: Am J Med. 2004 Aug 15;117(4):228-33
references.pmid: 15308431
references.citation: Am Heart J. 2008 Dec;156(6):1026-34
references.pmid: 19032996