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Recent trends in the treatment of post-myocardial infarction (MI) patients and the factors accounting for the improvement in outcome are presented. A total of 6,602 post-MI patients (5,320 males, 1,282 females; 58.9 +/- 10.4 years of age) enrolled between 1986 and 1999 were followed up for an average of 12.6 +/- 16.3 months. The incidence of cardiac events, which included fatal and nonfatal recurrent MIs, sudden death and death by congestive heart failure, was highest (44.9 events/1,000 person year) in 1986-1987, but decreased steadily to 22.5 events/1,000 person year by 1997-1999 (Trend p&lt;0.0001). This trend accompanied the increased use of coronary thrombolysis, percutaneous transluminal coronary angioplasty and coronary artery bypass graft surgery, increased prescription of antiplatelet agents (51.5%-83.4%), lipid-lowering agents (29.8%-52.6%) and angiotensin-converting enzyme inhibitors (5.3%--&gt;41.0%), and reduced prescription of calcium antagonists (68.5%-41.0%) and nitrates (60.7%--&gt;45.7%). These changes in treatment have led to a decreased incidence of angina pectoris, wall motion abnormalities and abnormal Q waves on electrocardiograms. The decline in the incidence of cardiac events among post-MI patients in the 14 years between 1986 and 1999 reflects implementation of new therapeutic modalities proven to be effective in clinical trials and in daily practice.

Modification of Treatment Strategies Over a Period of 14 Years Has Markedly Reduced Cardiac Events Among Post-Myocardial Infarction Patients.