Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2006 Apr;22(5):399-404.
doi: 10.1016/s0828-282x(06)70925-4.

Trends in five-year survival of patients discharged after acute myocardial infarction

Iqbal R Bata  1 , Ronald D Gregor, Hermann K Wolf, Brenda Brownell
Affiliations
Comparative Study

Trends in five-year survival of patients discharged after acute myocardial infarction

Iqbal R Bata et al. Can J Cardiol. 2006 Apr.

Abstract
in English, French

Background: It has previously been shown that the increased use of therapeutic intervention may not reduce patient fatality if there is a simultaneous increase in case severity. The present study was designed to extend the relationship between case severity and therapeutic interventions to long-term survival in the same study population.

Objective: To compare five-year survival of patients discharged after acute myocardial infarction from 1984 to 1988 and from 1989 to 1993, and to evaluate possible reasons for survival differences.

Methods: The present study was population-based. Survival time was determined by record linkage into the Canadian Mortality Database. Association of five-year survival with patient characteristics, in-hospital treatment and discharge medications was assessed by logistical regression analysis. Case severity was calculated as the probability of death within five years, given the patient profile and excluding any interventions.

Results: Between the two study periods, most patient characteristics and treatment intensity changed, but case severity for the study population remained constant. Five-year survival improved from 74.8% to 79.2% (P(chi2)=0.001). The improvement was adequately described by the combination of changes in patient profile and treatment without residual period effect (P(goodness-of-fit)=0.752). The treatments significantly associated with five-year survival were coronary artery bypass graft surgery (OR 2.74; 95% CI 1.86 to 4.05), percutaneous coronary intervention (OR 2.63; 95% CI 1.67 to 4.14) and thrombolysis (OR 1.98; 95% CI 1.50 to 2.62) during admission, as well as acetylsalicylic acid (OR 1.39; 95% CI 1.15 to 1.68) or beta-blocker (OR 1.60; 95% CI 1.34 to 1.92) prescription at discharge.

Conclusions: Changes in patient profile did not affect long-term prognosis; instead, treatment modalities accounted for the observed improvement in five-year survival.

HISTORIQUE: Il a déjà été démontré que l’augmentation des interventions thérapeutiques ne réduit pas toujours le risque de décès lorsque le cas devient concurremment plus grave. La présente étude a été conçue pour accroître le lien entre la gravité de la maladie associée aux interventions thérapeutiques et la survie à long terme d’une même population à l’étude.

OBJECTIF: Comparer le taux de survie au bout de cinq ans de patients ayant obtenu leur congé après un infarctus aigu du myocarde entre 1984 et 1988 et entre 1989 et 1993, et évaluer les raisons possibles pour expliquer les différences de survie.

MÉTHODOLOGIE: La présente étude était une étude de population. La durée de survie a été établie en reliant les dossiers avec la Base canadienne de données sur la mortalité. L’association entre la survie au bout de cinq ans et les caractéristiques des patients, le traitement pendant l’hospitalisation et les médicaments prescrits au congé a été évaluée au moyen d’une analyse de régression logistique. La gravité des cas a été calculée d’après la probabilité de décès au bout de cinq ans, compte tenu du profil du patient et en excluant toute intervention.

RÉSULTATS: Entre les deux périodes d’étude, la plupart des caractéristiques des patients et l’intensité des traitements ont changé, mais la gravité des cas de la population à l’étude est demeurée constante. La survie au bout de cinq ans est passée de 74,8 % à 79,2 % (Pχ2 =0,001). Cette amélioration a été décrite correctement comme la combinaison des changements de profil des patients et de traitement sans effet sur la période résiduelle (Pvalidité de l’ajustement=0,752). Les traitements associés de manière significative à la survie au bout de cinq ans étaient le pontage aortocoronarien (RR 2,74; 95 % IC 1,86 à 4,05), l’intervention coronaire percutanée (RR 2,63; 95 % IC 1,67 à 4,14) et la thrombolyse (RR 1,98; 95 % IC 1,50 à 2,62) pendant l’hospitalisation, de même que la prescription d’acide acétylsalicylique (RR 1,39; 95 % IC 1,15 à 1,68) ou de bétabloquants (RR 1,60; 95 % IC 1,34 à 1,92) au congé.

CONCLUSIONS: Les modifications au profil des patients n’ont pas eu de conséquences sur le pronostic à long terme. Ce sont plutôt les modalités de traitement qui expliquaient l’amélioration observée de la survie au bout de cinq ans.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Survival distribution functions for cases that occurred from 1984 to 1988 and from 1989 to 1993
Figure 2
Figure 2
The 95% CI for the OR of variables found to be significantly associated with five-year survival after discharge from hospital following an acute myocardial infarction (MI) between 1984 and 1993. ACE Angiotensin-converting enzyme; ASA Acetylsalicylic acid; CABG Coronary artery bypass graft surgery; LV Left ventricular; PCI Percutaneous coronary intervention
Figure 3
Figure 3
Cause of death as a percentage of all deaths occurring per survival interval. AMI Acute myocardial infarction; CAD Coronary artery disease; Mo Month; Vasc Vascular; y Year
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Terkelsen CJ, Lassen JF, Norgaard BL, et al. Mortality rates in patients with ST-elevation vs non-ST-elevation acute myocardial infarction: Observations from an unselected cohort. Eur Heart J. 2005;26:18–26. - PubMed
    1. Hanania G, Cambou JP, Gueret P, et al. Management and in-hospital outcome of patients with acute myocardial infarction admitted to intensive care units at the turn of the century: Results from the French nationwide USIC 2000 registry. Heart. 2004;90:1404–10. - PMC - PubMed
    1. Steg PG, Goldberg RJ, Gore JM, et al. Baseline characteristics, management practices, and in-hospital outcomes of patients hospitalized with acute coronary syndromes in the Global Registry of Acute Coronary Events (GRACE) Am J Cardiol. 2002;90:358–63. - PubMed
    1. Singh M, Reeder GS, Jacobsen SJ, Weston S, Killian J, Roger VL. Scores for post-myocardial infarction risk stratification in the community. Circulation. 2002;106:2309–14. - PubMed
    1. de Vreede JJ, Gorgels AP, Verstraaten GM, Vermeer F, Dassen WR, Wellens HJ. Did prognosis after acute myocardial infarction change during the past 30 years? A meta-analysis. J Am Coll Cardiol. 1991;18:698–706. - PubMed

Publication types

MeSH terms