Natural history of myocardial infarction and angina pectoris in a general population sample of middle-aged men: a 16-year follow-up of the primary prevention study, Goteborg, Sweden

Objectives, Although many studies have described prognosis in patients with coronary heart disease (CHD), few have compared outcome in men with clinic al evidence of CHD with healthy men from the general population over an ext ended follow-up, This study aimed to compare long-term prognosis in men wit h a history of myocardial infarction (MI) and in men with angina pectoris ( AP) without MI, with men without clinical signs of CHD. Design. Longitudinal general population study, Setting. City of Goteborg, Sweden. Subjects. From a general population sample, 195 men who had survived an MI for 0-19 years (median 3 pears) and 314 men with Ar but no MI (uncomplicate d AP) at baseline in 1974-77 were identified and compared with 6591 men wit hout clinical coronary disease. All were 51-59 years, Incident non-fatal an d fatal occurring until the beginning of 1983 were followed (n = 317). Main outcome measures, Death from CHD, from other causes and from all cause s during a follow-up of at least 16 years. Results, Overall survival was 72% amongst men without coronary disease, 53% amongst men with uncomplicated AP and 34% amongst men with past MI at base line. In survivors of MI the risk-factor-adjusted relative risk (RR) of cor onary death during follow-up was 6.67 (95% confidence interval (CI) 5.29-8. 39), of dying from non-cardiovascular causes 1.35 (0.96-1.91), and of dying from any cause 3.20 (2.67-3.83). During the first 4 years after the baseli ne examination, the adjusted RR of CHD death was 15.96 (10.29-24.74), and o f dying from any cause 5.22 (3.68-7.41). During the last 4 years of follow- up, relative risk was still 5.87 (3.44-10.01) for CHD death and 2.93 (2.05- 4.18) for death from any cause. In men with uncomplicated AP, the adjusted relative risk of CHD death during the first 4 years was 4.05 (2.27-7.22) an d 3.23 (2.10-4.96) during the last 4-year period. After the first year, the incident MI casts had the same average annual mortality (about 5%) as the prevalent cases. Conclusions, In survivors of MI, mortality remained high even after an exte nded follow-up. Men with angina had a better prognosis, but still a comprom ised survival compared with the general population.