title: Survival prospects after acute myocardial infarction in the UK: a matched cohort study 1987-2011.
abstract: Estimate survival after acute myocardial infarction (AMI) in the general population aged 60 and over and the effect of recommended treatments.
  
  
  
  Cohort study in the UK with routinely collected data between January 1987 and March 2011.
  
  
  
  310 general practices that contributed to The Health Improvement Network (THIN) database.
  
  
  
  4 cohorts who reached the age of 60, 65, 70, or 75 years between 1987 and 2011 included 16 744, 43 528, 73 728, and 76 392 participants, respectively. Participants with a history of AMI were matched on sex, year of birth, and general practice to 3 controls each.
  
  
  
  The hazard of all-cause mortality associated with AMI was calculated by a multilevel Cox's proportional hazards regression, adjusted for sex, year of birth, socioeconomic status, angina, heart failure, other cardiovascular conditions, chronic kidney disease, diabetes, hypertension, hypercholesterolaemia, alcohol consumption, body mass index, smoking status, coronary revascularisation, prescription of β-blockers, ACE inhibitors, calcium-channel blockers, aspirin, or statins, and general practice.
  
  
  
  Compared with no history of AMI by age 60, 65, 70, or 75, having had 1 AMI was associated with an adjusted hazard of mortality of 1.80 (95% CI 1.60 to 2.02), 1.71 (1.59 to 1.84), 1.50 (1.42 to 1.59), or 1.45 (1.38 to 1.53), respectively, and having had multiple AMIs with a hazard of 1.92 (1.60 to 2.29), 1.87 (1.68 to 2.07), 1.66 (1.53 to 1.80), or 1.63 (1.51 to 1.76), respectively. Survival was better after statins (HR range across the 4 cohorts 0.74-0.81), β-blockers (0.79-0.85), or coronary revascularisation (in first 5 years) (0.72-0.80); unchanged after calcium-channel blockers (1.00-1.07); and worse after aspirin (1.05-1.10) or ACE inhibitors (1.10-1.25).
  
  
  
  The hazard of death after AMI is less than reported by previous studies, and standard treatments of aspirin or ACE inhibitors prescription may be of little benefit or even cause harm.
authors.affiliation: School of Computing Sciences, University of East Anglia, Norwich Research Park, Norwich, UK.
authors.forename: Lisanne A
authors.initials: LA
authors.lastname: Gitsels
authors.affiliation: School of Computing Sciences, University of East Anglia, Norwich Research Park, Norwich, UK.
authors.forename: Elena
authors.initials: E
authors.lastname: Kulinskaya
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Steel
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000628:therapy*; D009204:Myocardial Revascularization; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D006113:United Kingdom
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002121:Calcium Channel Blockers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
keywords: All-cause mortality; PREVENTIVE MEDICINE; PRIMARY CARE