Published 26 January 2009, doi:10.1136/bmj.b36
Cite this as: BMJ 2009;338:b36

Research

Long term survival after evidence based treatment of acute myocardial infarction and revascularisation: follow-up of population based Perth MONICA cohort, 1984-2005

¹ School of Population Health M431, University of Western Australia, Crawley, Western Australia 6009, ² School of Medicine and Pharmacology M503, University of Western Australia, Crawley Western Australia 6009, ³ School of Population Health and Clinical Sciences NG45, University of Adelaide, South Australia 5005

Objective To examine trends in long term survival in patients alive 28 days after myocardial infarction and the impact of evidence based medical treatments and coronary revascularisation during or near the event.

Design Population based cohort with 12 year follow-up.

Setting Perth, Australia.

Participants 4451 consecutive patients with a definite acute myocardial infarction according to the World Health Organization MONICA (monitoring trends and determinants in cardiovascular disease) criteria admitted to hospital during 1984-7, 1988-90, and 1991-3.

Main outcome measures All cause mortality identified from official mortality records and the hospital morbidity data, with death from cardiovascular disease as a secondary end point.

Results In the 1991-3 cohort, 28 day survivors of acute myocardial infarction had a 7.6% absolute event reduction (95% confidence interval 4% to 11%) or a 28% lower relative risk reduction (16% to 38%), unadjusted for risk of death, over 12 years after the incident admission compared with the 1984-7 cohort, similar to the survival of the 1988-90 cohort. The improved survival for the 1991-3 cohort persisted after adjustment for demographic factors, coronary risk factors, severity of disease, and event complications with an adjusted relative risk reduction of 26% (14% to 37%), but this was not apparent after further adjustment for medical treatments in hospital and coronary revascularisation procedures within 12 months of the incident myocardial infarction.

Conclusion The improving trends in 12 year survival after a definite acute myocardial infarction are associated with progressive use of evidence based treatments during the initial admission to hospital and in the 12 months after the event. These changes in the management of acute myocardial infarction are probably contributing to the continuing decline in mortality from coronary heart disease in Australia.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Long term relative survival after surgery for abdominal aortic aneurysm in Western Australia: population based study

Paul E Norman, James B Semmens, Michael M D Lawrence-Brown, and C D'Arcy J Holman
BMJ 1998 317: 852-856. [Abstract] [Full Text] [PDF]

Secondary prevention of vascular disease by prolonged antiplatelet treatment

Antiplatelet Trialists' Collaboration
Br Med J (Clin Res Ed) 1988 296: 320-331. [Abstract] [PDF]

This article has been cited by other articles:

• (2009). MONICA Project Long-Term Survival Data. Journal Watch Cardiology 2009: 3-3 [Full text]  
• (2009). Long-Term Survival Benefits of Early Evidence-Based Treatment for AMI. JWatch Emergency Med. 2009: 2-2 [Full text]  

Rapid Responses:

Read all Rapid Responses

Explaining the recent declines in coronary deaths in Australia and beyond

Simon Capewell, et al.
bmj.com, 10 Feb 2009 [Full text]

Improving survival post myocardial infarction – does this translate to an increasing incidence of atrial fibrillation?

Kok-Hoon Tay, et al.
bmj.com, 19 Feb 2009 [Full text]

Online poll

Find out more on doc2doc >>