DETERMINANTS OF THE PROGNOSIS AFTER A FIRST MYOCARDIAL-INFARCTION IN A MIGRANT JAPANESE POPULATION - THE HONOLULU-HEART-PROGRAM

Background. Although numerous studies have been published on the progn ostic assessment of myocardial infarction, little is known about deter minants of the prognosis after a first myocardial infarction, especial ly regarding the role of standard risk factors for coronary heart dise ase (CHD) measured before the development of myocardial infarction. Me thods and Results. In a prospective study of CHD among men of Japanese ancestry living in Hawaii, 457 patients with a first myocardial infar ction (age range, 46 to 84 years) were identified during 20 years of f ollow-up. The relations of clinical variables and CHD risk factors to mortality in early (<30 days) and two stages of late (30 days to 5 yea rs and 5 to 10 years) periods after myocardial infarction in these pat ients were investigated. In multivariate analyses using logistic regre ssion models (for early mortality) and Cox regression models (for late mortality), age at myocardial infarction and severe complications (Ki llip classes 3 and 4) were independent predictors of both early and la te mortality (up to 5 years after myocardial infarction). In addition, ventricular arrhythmias predicted only early mortality, whereas anter ior myocardial infarction, radiological evidence of cardiomegaly and/o r pulmonary congestion, and intraventricular block predicted only late mortality (up to 5 years after myocardial infarction). Only age was a n independent predictor of all-cause mortality more than 5 years after myocardial infarction. After adjusting for age at myocardial infarcti on and these clinical variables, preinfarction-measured risk factors s uch as I-hour postload serum glucose (positively) and 1-second forced expiratory volume (inversely) were significantly associated with late mortality up to 5 years, whereas systolic blood pressure was the only independent predictor of late mortality after 5 years. Conclusions. Th is study has confirmed the importance of age at myocardial infarction and clinical indicators of complications such as Killip class 3 or 4, radiological evidence of pulmonary congestion, and ventricular arrhyth mias or intraventricular block as the prognostic determinants of myoca rdial infarction. In addition, some of the preinfarction-measured stan dard risk factors for CHD were found to predict long-term prognosis in dependent of age and clinical factors.