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      Long-Term Mortality Rates Reflect Progressive Prognostic Benefits of Thrombolysis in Patients with First Acute Myocardial Infarction


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          This community nonrandomized study comprised a consecutive cohort of 1,545 (81% males) ≤65-year-old patients who survived a first acute myocardial infarction (AMI). The all-cause 4- to 5-year mortality rate was 9% (80% cardiac). Univariate analysis revealed that older age, female gender, hypertension, diabetes, not undergoing thrombolysis, higher Killip class, preinfarction heart disease, peripheral vascular disease (PVD) and chronic obstructive lung disease (COLD) were significantly associated with increased mortality. Multivariate analyses disclosed the latter five parameters as being independent predictors of mortality. Our results show that patients undergoing thrombolysis enjoyed a progressive prognostic benefit over time. The independent contribution of PVD and COLD to long-term mortality is highlighted, in addition to the contribution of thrombolytic therapy, Killip class, and heart disease prior to infarction as being important predictors of long-term mortality in patients with a first AMI.

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          Most cited references7

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          ACC/AHA guidelines for the management of patients with acute myocardial infarction

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            Age-related increase in mortality among patients with first myocardial infarctions treated with thrombolysis. The Investigators of the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico (GISSI-2).

            The overall rate of mortality due to ischemic heart disease is known to increase progressively with age. We evaluated the relation between the mortality rate and age in patients with first myocardial infarctions treated with thrombolytic therapy. We studied 9720 patients with first infarctions who had been enrolled in the GISSI-2 trial. (This trial compared the efficacy of tissue plasminogen activator with that of streptokinase in patients with myocardial infarction.) Of these, only 35 percent had a history of angina. The relation between age and mortality during hospitalization and during the six months after discharge was determined by unadjusted and adjusted analyses. The in-hospital mortality rate was 1.9 percent among patients 40 years old or younger, but it increased to 31.9 percent among those more than 80 years old; however, values for indicators of infarct size did not increase with age. Autopsies were performed in 20 percent of the 772 patients who died in the hospital; the findings showed that the frequency of cardiac rupture increased from 19 percent among patients 60 years old or younger to 86 percent among those more than 70 years old. The mortality rate for the first six months after hospital discharge also increased significantly with age. After adjustment for confounding variables, older age continued to be significantly associated with a higher risk of in-hospital and post-discharge death. When age was introduced into a multivariate model as a continuous variable, the risk of death was estimated to increase by about 6 percent per year for both in-hospital and six-month mortality rates. In patients with first myocardial infarctions who received thrombolytic therapy, age was a powerful independent predictor of both in-hospital and post-discharge mortality rates. The exponential, age-related increase in the mortality rate did not appear to be explained by larger infarcts.
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              Mortality Differences Between Men and Women Following First Myocardial Infarction


                Author and article information

                S. Karger AG
                January 2001
                12 January 2001
                : 94
                : 2
                : 111-117
                Departments of aCardiology, bMedicine T and dBiostatistics, Tel Aviv Sourasky Medical Center, cDepartment of Epidemiology and Preventive Medicine, eCardiac Rehabilitation Institute, Chaim Sheba Medical Center, Tel Hashomer, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
                47302 Cardiology 2000;94:111–117
                © 2001 S. Karger AG, Basel

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                Page count
                Figures: 1, Tables: 4, References: 47, Pages: 7
                Coronary Care


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