Premium
The impact of morbid events on survival following hospitalization for complicated myocardial infarction
Author(s) -
Dickstein Kenneth,
Gleim Gilbert W.,
Snapinn Steven,
James Margaret K.,
Kjekshus John
Publication year - 2006
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1016/j.ejheart.2005.04.010
Subject(s) - medicine , myocardial infarction , revascularization , hazard ratio , stroke (engine) , proportional hazards model , heart failure , cause of death , cardiology , emergency medicine , confidence interval , disease , mechanical engineering , engineering
Background: Little is known about the importance of morbid events with respect to longer term survival following MI hospital discharge. Aims: Establish the risk of death associated with morbid events following initial discharge from MI hospitalization. Methods: We examined the rates of morbid events (reinfarction, stroke/TIA, revascularization, heart failure (HF) hospitalization, cardiovascular hospitalization and all‐cause hospitalization) and the relationships of these events to subsequent death in patients who survived the initial hospitalization for MI ( n =5301) in the OPTIMAAL trial. Events were classified as Early (≤30 days post discharge) and Late (>30 days post discharge) for an average of 2.7 years follow‐up. Results: Death rates were higher in the Early period (0.20 deaths/patient year) than in the Late period (0.05 deaths/patient year). Once a morbid event, excluding revascularization, occurred, the acute hazard ratios (HR, determined by Cox regression) for death on the day of event were higher than at time periods following the event and were highest for reinfarction and stroke/TIA. The acute HRs for death for all 6 morbid events were especially high for events occurring during the Late period. The highest chronic HR for death was associated with HF and all‐cause hospitalizations. By contrast, the chronic HR for death from revascularization in both the Early (HR=0.3) and Late (HR=0.4) period indicated reduced risk. Conclusions: The results document event rates following hospitalization for MI, provide quantification of the associated risk for death, and may be useful in designing clinical trials. The serious morbid events examined may serve as potential surrogate endpoints in long‐term studies and identify patients that should be targeted for aggressive management.