© 2001 European Society of Cardiology
Prognosis of acute myocardial infarction in the thrombolytic era: medical evaluation is still valuable
a Heart Institute (InCor),University of São Paulo Medical School Brazil
b Instituto de Moléstias Cardiovasculares São José do Rio Preto, SP, Brazil
* Corresponding author. Rua Aureliano Coutinho 355-14° andar, São Paulo, SP 01224-020, Brazil. Tel.: 55-11-3069-5058; fax: +55-11-3088-3809. E-mail address: corjnicolau{at}incor.usp.br (J.C. Nicolau)
 |
Abstract |
|---|
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.
Key Words: Acute myocardial infarction • Medical evaluation • Long-term follow-up • Thrombolysis
Received September 19, 2000; Revised December 12, 2000; Accepted January 19, 2001