MORTALITY RISK AND PATTERNS OF PRACTICE IN 2,070 PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION, 1987-92 - RELATIVE IMPORTANCE OF AGE, SEX, AND MEDICAL THERAPY

Objective: To define contemporary age- and sex-related mortality risks and patterns of medical practice in acute myocardial infarction (AMI) . Design: Retrospective comparison of demographic and clinical variabl es, including the use of proven effective AMI medical therapy, among A MI patient cohorts from 1987 to 1992. Patients/Setting: Of a total of 2,070 AMI patients, 629 were women and 1,441, men; 951 patients were m anaged in university hospitals, 641 in a regional hospital, and 478 in community hospitals. Interventions: No direct study interventions; re sults of practice patterns and risk analyses of the earlier (1987-90) AMI cohorts, however, were published concurrently with the actual prac tices of the more recent (1991-92) cohorts and may have had some indir ect effect on the recent practice patterns. Results: Univariate analys is showed that mortality was higher (p<0.0001) and use of thrombolysis , beta blockers, and acetylsalicylic acid was lower (p<0.0001) in pati ents 70 years of age and older, compared with younger patients, and in women, compared with men. Multivariate analysis of the entire patient sample revealed age of 75 years or older (154 percent) and age 70 to 74 years (141 percent) to be associated with the highest relative risk of death in hospital. The increased relative risk associated with pre vious AMI was 45 percent. Acetylsalicylic acid use was associated with the greatest decrease in relative risk of death (-69 percent), follow ed by beta blockers (-36 percent) and thrombolysis (-31 percent). Thes e patterns of relative risk were the same for men and women. Conclusio ns: Among contemporary AMI patients, advanced age and female sex are a ssociated with relative under-utilization of proven effective medical therapy and increased risk of dying in the hospital. Although the cont ribution of age to AMI risk appears greater than that of gender, survi val in any high risk group would likely be improved by increased use o f proven medical therapy.