SURVIVAL IN ACUTE MYOCARDIAL-INFARCTION I N 369 CONSECUTIVE PATIENTS ADMITTED BETWEEN 1988 AND 1992 - AN ANALYSIS OF RISK-FACTORS AND MEDICAL MANAGEMENTS

A retrospective analysis without exclusion of 369 consecutive cases of myocardial infarction admitted between January 1988 and March 1992 st udied the risk factors, previous medical history and treatment in this period during which medical practice seemed to be standardised with a cknowledged benefits of thrombolysis, beta-blockade and aspirin therap y. The population observed is divided in three age groups (< 65, > 65 < 75 and > 75). A Cox model multi-variate analysis for age, sex, diabe tes, hypertension, hypercholesterolaemia, tobacco, smoking, previous i nfarction, coronary artery disease and cardiac failure underlined the risk related to age which was 3.2 for patients 65-75 years of age and 4 for patients over 75 years of age. The risk was high in women (1.4), diabetes (1.5) and previous infarction (1.7). The excess mortality of the elderly age groups could also have been related to medical manage ment as the most effective treatments were less commonly used. Thrombo lysis was used in 44 % of patients under 65 years of age but in only 9 .7 % of patients over 75 years; betablockers were prescribed in 77.6 % of the younger but only in 27.4 % of the older patients. The same ten dency was observed in the administration of aspirin, with 81.6 % recei ving this drug in the younger patients compared to only 61 % in older patients. Differences in survival at 6 months according to age (93.6 % , 74 % and 54.9 %) show that there is a clearly defined therapeutic ob jective over 65 years of age with a large field of action and a probab ility of significant improvement in mortality and morbidity.