LONG-TERM PROGNOSIS AFTER A FIRST MYOCARDIAL-INFARCTION IN TURKEY - DETERMINANTS OF MORTALITY AND REINFARCTION

Long-term prognosis of a first myocardial infarction and factors assoc iated with late cardiac mortality and reinfarction were studied in 718 survivors. Patients have been followed up for 1-10 years (mean 57.6 /- 39.6 months). None of the patients underwent coronary bypass surger y in the follow-up period. Cumulative mortality rates were 8.6% in the first year, 17.9% in 3 years, 26.4% in 5 years and 36.5% in 10 years. The type and site of myocardial infarction (Q-wave versus non-Q-wave and anterior versus infero-posterior) were found to have no independen t prognostic importance. The cardiac mortality was best predicted by t he occurrence of congestive heart failure in the coronary care unit. O ther determinants of late outcome were the presence of ventricular arr hythmias, left bundle branch block, and the occurrence of stable or un stable angina pectoris or reinfarction during the follow-up period. Us age of antiplatelet or anticoagulant drugs was not found to affect mor tality. Reinfarction rates were 4, 9.9, 15.5 and 28% in 1, 3, 5 and 10 years, respectively, and no relation was found between the type and l ocation of myocardial infarction and reinfarction rate. Reinfarction w as higher in patients receiving anticoagulants and in patients with po stmyocardial infarction angina. Our findings suggest that the prognosi s of patients with a first acute myocardial infarction in Turkey is no t different from that in Western populations and factors influencing p rognosis are similar to those previously reported.