Cor Vasa 2004, 45(7):319-325

Change in the fate of middle-aged men with acute myocardial infarction

Vladimír Staněk¹, Marie Gebauerová¹, Jan Horák², Petr Frídl¹, Růžena Jandová¹, Jiří Kettner¹, Jan Šochman¹, Jana Vrbská¹, Martin Wiendl¹, Jaroslav Ulman¹, Michael Želízko¹

¹ Klinika kardiologie, Institut klinické a experimentální medicíny

² II. interní klinika, Všeobecná fakultní nemocnice a 1. lékařská fakulta Univerzity Karlovy, Praha, Česká republika

Aim:
The aim of our retrospective study was to evaluate the prognosis of males admitted to a coronary care unit with ST-segment elevation acute myocardial infarction in three periods characterized by different treatment strategies.


Patients and method:
The analysis was carried out in three series of male patients below 65 years of age. The first group of 362 men was hospitalized over the 1973-1977 period when no reperfusion therapy was available. The second group of 372 males was hospitalized over the 1991-1995 period when the general practice was thrombolytic therapy with streptokinase in all patients presenting within 6 hours, and the third group of 342 males hospitalized in the 1996-2000 period when the main therapeutic strategy was emergency coronary intervention. The above groups represent the whole number of patients admitted, as documented by the patient admission records and selected by the admission EKG curve and age.

Results:
The median admission time decreased progressively from 5.5 hours in the 1970s to 3.0 and 2.7 hours in subsequent series. In-hospital mortality decreased from 16.6% to 8.7% and 4.1%, respectively (p < 0,001). The degree of left ventricular injury was assessed in patients suffering their first anterior wall myocardial infarction and assigned to groups in the thrombolysis and interventional periods. A significant difference was seen in patients admitted within four hours since onset of complaints. The finding of Q waves on the EKG curve on discharge was reported in 90.9% in the 1991-1995 period and in 45.6% in the 1996-2000 period (p < 0.001); a decrease in ejection fraction below 40 % on discharge was seen in 55.5% in the 1991-1995 period, and in 22.8% in the 1996-2000 period (p < 0,001). There were no significant differences in patients admitted within 4 hours of onset. The relevance of early admission stands out particularly in the intervention treatment period. This period has been shown to be associated not only with a smaller resultant injury in patients admitted within 4 hours since onset of complaints compared with patients admitted after 4 hours (2.2 and 9.3%, p < 0.01). The late two-year mortality of men surviving the in-hospital phase of myocardial infarction tended to decline over the above periods from 17.8 to 3.8 and 1.0% (p < 0.001).

Keywords: Srdeční infarkt s elevacemi ST; Prognóza; Funkce levé komory; Primární angioplastika; Trombolýza

Published: July 1, 2004  Show citation