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Prognosis of acute myocardial infarction in the thrombolytic era: medical evaluation is still valuable
Author(s) -
Nicolau José C.,
Serrano Carlos V.,
Garzon Sérgio A.C.,
Ramires José A.F.
Publication year - 2001
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/s1388-9842(01)00170-2
Subject(s) - medicine , myocardial infarction , streptokinase , ejection fraction , cardiology , proportional hazards model , heart failure , population , multivariate analysis , environmental health
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.