Excess long-term mortality among hospital survivors of acute myocardial infarction. Soroka Acute Myocardial Infarction (SAMI) project

doi:10.1016/j.puhe.2016.09.032

Public Health

Volume 143, February 2017, Pages 25-36

https://doi.org/10.1016/j.puhe.2016.09.032 Get rights and content

Highlights

•
Acute myocardial infarction (AMI) survivors are twice as likely to die in a 10-year follow-up period compared with the matched general population.
•
Mortality excess is greatest in young women, high risk patients, Jews, NSTEMI, non-invasively treated and recurrent AMI.
•
Mortality excess is observed most prominently throughout the 1st year followed by the 7th–10th years after AMI.

Abstract

Objectives

We evaluated long-term survival after acute myocardial infarction (AMI) in unselected ‘real life’ patients according to the various risk groups, and it's persistence with time after AMI as compared with the matched general population.

Study design

Retrospective study.

Methods

Data were collected from 2671 AMI hospital survivors (tertiary medical centre in Israel), which included demographics, clinical characteristics of AMI, comorbidities, interventions and test results. All-cause mortality during the 10-year follow-up period was compared with age-, sex- and ethnicity/religion-matched general population using standardized mortality ratios (SMRs).

Results

Overall mortality of AMI patients (48.6%) was higher than the general population (SMR, 2.2; P < 0.001). Mortality rates and SMRs tended to be greater in higher risk strata of patients, Jews vs Muslims, women vs men, non–ST-elevation acute myocardial infarction (NSTEMI) vs ST-elevation acute myocardial infarction (STEMI), non-invasive treatment vs invasive treatment, and recurrent vs first AMI. Mortality rates increased with age, but SMRs were highest in the youngest group. Through the follow-up period, SMR was highest during the first year after discharge (SMR, 4.85; P < 0.001) and higher in 7th–10th years compared with 2nd–6th years.

Conclusion

Patients who survived hospital admission with AMI continue to be at higher (approximately twice) risk of death compared with the general population for at least 10-year follow-up period and especially throughout the first and 7th–10th years after AMI, young women, high-risk patients, Jews, NSTEMI, non-invasively treated and recurrent AMI. These findings can assist healthcare providers and decision makers prioritizing targets of secondary prevention and allocation of resources.

Introduction

Over the past decades, medical advancements in the management of patients with acute myocardial infarction (AMI) led to improved survival and increased life expectancy, mostly in developed countries.1, 2 As short-term survival from AMI continues to improve, more attention is being shifted towards understanding and improving long-term outcomes.3, 4, 5, 6 Long-term prognosis after an AMI varies with the presence of different risk factors. These factors have been extensively investigated as a part of long-term prognostic indexes.4, 7, 8, 9 Recent studies from England and Canada found excessive mortality in AMI patients compared with general population up to 7- and 5-year post-AMI follow-up, respectively.10, 11

In the present study, we evaluate long-term (up to 10 years) mortality rates of hospitalized AMI survivors as compared with those of general population according to sex, ethnicity/religion, age and risk strata. We also evaluate the extent of the excessive mortality, yearly throughout the follow-up post-AMI period.

Section snippets

Study population

In this retrospective study, we used the database of Soroka Acute Myocardial Infarction (SAMI) project,9, 12 including patients who had been admitted in Soroka University Medical Center (SUMC) for AMI between January 1, 2002 and October 31, 2004 and discharged alive. Subjects with unknown ethnicity/religion or those with ethnicity/religion other than Jews or Muslims were excluded in the present study.

SUMC is a tertiary referral centre (∼1200 beds), singly serving the metropolitan area of

Results

Out of 2773 subjects, 102 were excluded due to unknown ethnicity/religion, and 2671 were included in the cohort. An additional 26 subjects were excluded from analyses relating to risk strata due to missing data for risk index calculation.

The age of the full cohort distributed between 25.7 and 101.5 years, with a mean of 66.9 (SD, 13) years, 33% were women and 11% were Muslims. Baseline characteristics for the full cohort and according to the risk strata are presented in Table 1.

Higher risk

Discussion

The present study provides a comprehensive account of 10-year mortality risk in hospitalized AMI survivors in Israel between 2002 and 2004. Overall, the present study shows that hospital survivors continue to be a high-risk group of patients with about half of survivors dying within the 10-year follow-up period, resulting in an overall mortality rate of 2.2 times higher than age-, sex- and ethnicity/religion-matched general population. This finding is in consistency with studies from England

Ethical approval

Soroka University Medical Center ethics committee.

Funding

None declared.

Competing interests

None declared.

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Original ResearchExcess long-term mortality among hospital survivors of acute myocardial infarction. Soroka Acute Myocardial Infarction (SAMI) project

Highlights

Abstract

Objectives

Study design

Methods

Results

Conclusion

Introduction

Section snippets

Study population

Results

Discussion

Ethical approval

Funding

Competing interests

Contemp Clin Trials

Int J Cardiol

Int J Cardiol

Can J Cardiol

Int J Cardiol

Am J Cardiol

Womens Health Issues

Am Heart J

J Cardiol

Am J Cardiol

Acute coronary care in the elderly, part I: non-ST-segment-elevation acute coronary syndromes: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology

Circulation

Temporal decline in the prognostic impact of a recurrent acute myocardial infarction 1985 to 2002

Heart

The future of clinical trials in secondary prevention after acute coronary syndromes

Eur Heart J

Predicting long-term mortality in older patients after non-ST-segment elevation myocardial infarction: the CRUSADE long-term mortality model and risk score

Am Heart J

Predictors of hospital mortality in the global registry of acute coronary events

Arch Intern Med

The TIMI risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making

JAMA

Long-term survival and recurrence after acute myocardial infarction in England, 2004 to 2010

Circ Cardiovasc Qual Outcomes

Original Research
Excess long-term mortality among hospital survivors of acute myocardial infarction. Soroka Acute Myocardial Infarction (SAMI) project