HAS HOSPITAL MORTALITY FROM ACUTE MYOCARDIAL-INFARCTION BEEN MARKEDLYREDUCED SINCE THE INTRODUCTION OF THROMBOLYTICS AND ASPIRIN

Objectives, There are conflicting views on how hospital mortality with respect to acute myocardial infarction (AMI) has changed since the in troduction of thrombolytics and aspirin, Our purpose therefore wa:; to explain this by studying hospital mortality in a nonselected AMI popu lation, and then assess how patients allocated to different treatment groups contribute to overall mortality, Design, Extensive data were co llected on all AMI patients admitted to the 10 hospitals in health reg ion 1 (population 850 000) in Norway during a 2 month period, A protoc ol approved by the European Secondary Prevention Study Group was used. Results, Of the 487 patients, 32% received thrombolytics, 72% aspirin and 22% none of the treatments. Average in-hospital mortality was 18% , Mortality within the different groups was as follows: no thrombolyti cs nor aspirin group 35.0% (39/111), aspirin group 13.7% (30/218), thr ombolytics group 17.3% (4/23), and thrombolytics plus aspirin group 11 .0% (15/135). The characteristics of the nontreated group compared to the aspirin and aspirin plus thrombolytics groups were more females, o lder, increased frequency of previous AMI, left ventricular failure, c ardiopulmonary resuscitation, history of stroke and peptic ulcer, and electrocardiogram (ECG) findings, other than ST elevation. Conclusion, In a nonselected AMI population, a patient group receiving neither th rombolytics nor aspirin contributed most significantly to an overall h igh mortality. This indicates a modest reduction in total AMI mortalit y after the new therapies were introduced, as the mortality for this g roup, with a high risk profile, has presumably remained unchanged.