Ten year mortality in patients with suspected acute myocardial infarction

Abstract

urinary tract infection must be suspected, diagnosed, and treated rapidly in infancy and childhood and further infection prevented during follow up. It is also essential to identify vesicoureteric reflux early by investigation with cystography in infants with antenatal dilatation of the urinary tract, infants and young children after a first urinary infection, and siblings and offspring of patients with renal scarring. These measures will reduce the risk in children of the later development of reflux nephropathy and its complications. Main outcome measures-Death and cause of death. Standardised mortality ratio (observed mortality/expected mortality in background population).Results-The estimated 10 year mortalities were 58-80/o 55.5%/ and 428/o in patients with definite, probable, and no infarction, respectively (P < 0 0001). Stratified Cox's analysis identified a hazard ratio for mortality of 1*25 (95% confidence interval 108 to 1.44) for probable infarction compared with no infarction and of 115 (1.00 to 1.32) for definite compared with probable infarction. The standardised mortality ratio in the first year was 7-1 (6 5 to 7.8) for definite infarction, 5.0 (3.6 to 6 3) for probable infarction, and 4-7 (4-2 to 5.2) for no infarction. From the second year and onwards the annual standardised mortality ratio in the three groups did not differ significantly. Cardiac causes of deaths were recorded in 890/o, 84%, and 71% of the deaths in patients with definite, probable, and no infarction, respectively.Conclusions-The 10 year mortality of patients with and without infarction is significantly higher than in the background population. Most deaths are caused by coronary heart disease, and these patients should consequently be further evaluated at the time ofdischarge and followed up closely.

Sustained benefit at 10–14 years follow-up after thrombolytic therapy in myocardial infarction

“…Our analysis shows that an annual mortality rate of about 2·6-3·3% can be anticipated in patients surviving their first myocardial infarction for 1 year. This annual mortality rate continues to be about twice as high as the reference population throughout 10 years, which is in agreement with another study [19] . When the parameters of infarct size or residual left ventricular function were included in the model, multivariate analysis did not indicate any contribution of thrombolytic therapy.…”

Gender differences in management and outcome of patients with acute myocardial infarction

“…In fact, apart from some isolated studies [2], the female sex has been found to be an independent predictor of worse prognosis in patients with coronary heart disease. This has been a consistent finding in a wide range of studies of first acute myocardial infarction [3] (AMI) and post-AMI periods [4] across numerous countries [5][6][7][8][9][10][11] and in reports of atypical presentation forms [12]. However, it remains unclear whether this higher mortality is explained by the higher age of females or presence of other risk factors, notably diabetes [13].…”

Systematic review and modelling of the investigation of acute and chronic chest pain presenting in primary care

“…9 However, it is unclear to what extent this expenditure could have been avoided, since the standardised mortality ratio of patients admitted to hospital with suspected MI where a final diagnosis of 'no infarction' was made was found to be 4.7 [95% confidence interval (CI) 4.2 to 5.2] in the first year following the admission. 10 Therefore, it is likely that these patients do require investigation and treatment.…”