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      Improved One-Year Survival afterAcute Myocardial Infarction in Iceland between 1986 and 1996

      a , b

      Cardiology

      S. Karger AG

      Acute myocardial infarction, Treatment, Prognosis, Mortality

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          Abstract

          During the last decade the treatment of patients with acute myocardial infarction (AMI) has changed dramatically. In order to evaluate the overall impact of these changes on mortality and morbidity, we collected data on all patients hospitalized for AMI in Reykjavik, Iceland, during the calendar years of 1986 and 1996. Demographical characteristics of AMI patients did not change significantly between study periods. One-year mortality decreased from 26.3 to 19.7% (p < 0.05). Patients discharged with aspirin or β-antagonists as well as those who received thrombolytic therapy had decreased 1-year mortality both years. Patients discharged with diuretics, digoxin or antiarrhythmics had increased 1-year mortality. We conclude that the 25% reduction in 1-year mortality is partially due to changes in therapy.

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          Most cited references 4

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          Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S)

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            Effect of beta-blockade on mortality among high-risk and low-risk patients after myocardial infarction.

            Long-term administration of beta-adrenergic blockers to patients after myocardial infarction improves survival. However, physicians are reluctant to administer beta-blockers to many patients, such as older patients and those with chronic pulmonary disease, left ventricular dysfunction, or non-Q-wave myocardial infarction. The medical records of 201,752 patients with myocardial infarction were abstracted by the Cooperative Cardiovascular Project, which was sponsored by the Health Care Financing Administration. Using a Cox proportional-hazards model that accounted for multiple factors that might influence survival, we compared mortality among patients treated with beta-blockers with mortality among untreated patients during the two years after myocardial infarction. A total of 34 percent of the patients received beta-blockers. The percentage was lower among the very elderly, blacks, and patients with the lowest ejection fractions, heart failure, chronic obstructive pulmonary disease, elevated serum creatinine concentrations, or type 1 diabetes mellitus. Nevertheless, mortality was lower in every subgroup of patients treated with beta-blockade than in untreated patients. In patients with myocardial infarction and no other complications, treatment with beta-blockers was associated with a 40 percent reduction in mortality. Mortality was also reduced by 40 percent in patients with non-Q-wave infarction and those with chronic obstructive pulmonary disease. Blacks, patients 80 years old or older, and those with a left ventricular ejection fraction below 20 percent, serum creatinine concentration greater than 1.4 mg per deciliter (124 micromol per liter), or diabetes mellitus had a lower percentage reduction in mortality. Given, however, the higher mortality rates in these subgroups, the absolute reduction in mortality was similar to or greater than that among patients with no specific risk factors. After myocardial infarction, patients with conditions that are often considered contraindications to beta-blockade (such as heart failure, pulmonary disease, and older age) and those with nontransmural infarction benefit from beta-blocker therapy.
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              One-Year Mortality after Acute Myocardial Infarction prior to and after the Implementation of a Widespread Use of Thrombolysis and Aspirin

              During 1 year of follow-up, we compared the mortality after acute myocardial infarction (AMI) prior to and after the introduction of a more widespread use of thrombolytic agents and aspirin. Study period: Two periods (I = 1986–1987 and II = 1989–1990) were compared. Patients: All patients admitted to the coronary care units at the two city hospitals in the community of Göteborg who fulfilled the criteria for development of AMI participated in the evaluation. Results: The overall 1-year mortality rate was 24% during period I and 23% during period II (NS). However, among patients up to 70 years of age, the mortality was reduced from 15 to 11% (p < 0.05), whereas among patients aged over 70 years the mortality remained almost unchanged (34 vs. 35%; NS). Conclusion: The introduction of a more widespread use of thrombolytic agents and aspirin has not substantially changed the overall mortality in AMI. However, among younger patients, the mortality appears to have been reduced but not among the elderly.
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                Author and article information

                Journal
                CRD
                Cardiology
                10.1159/issn.0008-6312
                Cardiology
                S. Karger AG
                0008-6312
                1421-9751
                1999
                September 1999
                24 September 1999
                : 91
                : 3
                : 210-214
                Affiliations
                aUniversity of Iceland, Faculty of Medicine, and bDepartment of Medicine, Reykjavik City Hospital, Reykjavik, Iceland
                Article
                6912 Cardiology 1999;91:210–214
                10.1159/000006912
                10516417
                © 1999 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 2, Tables: 3, References: 16, Pages: 5
                Categories
                Coronary Care

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