Trends in in-hospital mortality and six-month outcomes in patients with a first acute myocardial infarction. Change over the last decade

Abstract

Introduction and objectives: Treatment of acute myocardial infarction (AMI) has changed considerably in recent years. The objective of this study was to investigate differences in in-hospital mortality and 6-month outcomes after a first AMI between patients who participated in two trials, in 1992-1994 and 2001-2003, respectively.

Methods: The study involved 1440 consecutive patients with a first AMI who were admitted to four university hospitals during 1992-1994 (the RESCATE-I trial) and 1288 with a first AMI who met the same diagnostic criteria and who were admitted to the same hospitals during 2001-2003 (the RESCATE-II trial). Patient management, in-hospital mortality and 6-month prognosis and outcomes were compared between the two trials.

Results: Reperfusion therapy was carried out in 60.7% of patients in the first trial and in 72.6% in the second (P< .001). In the RESCATE-II trial, the median door-to-needle time was shorter (41 min vs. 93 min; P< .001) and patients more frequently underwent coronary angiography (65.2% vs. 28.1%; P< .001) and revascularization (34.9% vs. 8.1%; P< .001). In addition, in-hospital mortality was lower in RESCATE-II (7.5% vs. 10.9%; P< .001). After adjustment for age, sex, comorbidity, AMI severity and reperfusion therapy, the odds ratio for in-hospital mortality in RESCATE-II compared with the first trial was 0.52 (95% confidence interval, 0.31-0.86). In addition, mortality (1.4% vs. 3.6%; P=.001) and readmissions at 6 months were also lower in RESCATE-II.

Conclusions: Both in-hospital and 6-month mortality in patients with a first AMI decreased during the last decade, probably due to more frequent reperfusion and revascularization therapy and better medical treatment.