Prognosis of acute myocardial infarction in the thrombolytic era: medical evaluation is still valuable

• Published in: European journal of heart failure Vol. 3; no. 5; pp. 569 - 576
• Main Authors: Nicolau, José C., Serrano Jr, Carlos V., Garzon, Sérgio A.C., Ramires, José A.F.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01-10-2001; Elsevier
• Subjects: acute myocardial infarction; Coronary Angiography; Female; Humans; long-term follow-up; Male; medical evaluation; Middle Aged; Multivariate Analysis; Myocardial Infarction - drug therapy; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Prognosis; Survival Rate; thrombolysis; Thrombolytic Therapy; Time Factors; Long-term follow-up; Acute myocardial infarction; Thrombolysis; Medical evaluation
• ISSN: 1388-9842; 1879-0844
• DOI: 10.1016/S1388-9842(01)00170-2

Background:
Modern and sophisticated technology for the management of myocardial infarction has progressively devalued medical evaluation.
Hypothesis:
This study was undertaken to assess the importance of the findings of medical evaluation at hospital presentation, in patients with acute myocardial infarction.
Methods:
Data from 590 thrombolytic-treated myocardial infarction patients were analyzed. The patients were grouped according to their clinical status on arrival at hospital. A modified Forrester classification - subset II was divided according to the absence (IIa) or presence (IIb) of symptoms - was applied. Short- (14 days) and long-term (up to 10 years) survival was analyzed and 19 independent variables were included in the multivariate models.
Results:
Short-term survival was 95.6% for subset I, 83.3% for subset IIa, 60% for subset IIb, 54.6% for subset III, and 34.8% for subset IV (P < 0.001). By multiple regression analysis, lower clinical subsets (P < 0.001), fewer coronary arteries with disease (P = 0.006), younger age (P = 0.014), absence of reinfarction (P = 0.034), longer interval between streptokinase infusion and coronary arteriography (P = 0.016), and higher left ventricular ejection fraction (P = 0.037) demonstrated significant and independent correlation with short-term survival. Long-term survival for the total population was 71 ± 3.6% for subset I, 54.4 ± 8.5% for subset IIa, 20.8 ± 9.4% for subset IIb, 54.5 ± 15% for subset III, and 0% for subset IV (P < 0.001). Using Cox regression analysis, lower clinical subsets (P < 0.001), younger age (P < 0.001), higher global left ventricular ejection fraction (P < 0.001), and fewer coronary arteries with disease (P = 0.021) correlated independently and significantly with long-term survival. When excluding data from patients who died before the short-term follow-up (n = 532), lower clinical subsets remained an important predictor of long-term survival (P < 0.001).
Conclusion:
Clinical classification at hospital presentation is a powerful predictor of short- and long-term survival post-myocardial infarction.