Hospital mortality of acute myocardial infarction in the thrombolytic era

Objective-To examine the management and outcome of an unselected consecutiv e series of patients admitted with acute myocardial infarction to a tertiar y referral centre. Design-A historical cohort study over a three year period (1992-94) of cons ecutive unselected admissions with acute myocardial infarction identified u sing the HIPE (hospital inpatient enquiry) database and validated according to MONICA criteria for definite or probable acute myocardial infarction. Setting-University teaching hospital and cardiac tertiary referral centre. Results-1059 patients were included. Mean age was 67 years; 60% were male a nd 40% female. Rates of coronary care unit (CCU) admission, thrombolysis, a nd predischarge angiography were 70%, 28%, and 32%, respectively. Overall i n-hospital mortality was 18%. Independent predictors of hospital mortality by multivariate analysis were age, left ventricular failure, ventricular ar rhythmias, cardiogenic shock, management outside CCU, and reinfarction. Hos pital mortality in a small cohort from a non-tertiary referral centre was 1 4%, a difference largely explained by the lower mean age of these patients (64 years). Five year survival in the cohort was 50%. Only age and left ven tricular failure were independent predictors of mortality at follow up. Conclusions-In unselected consecutive patients the hospital mortality of ac ute myocardial infarction remains high (18%). Age and the occurrence of lef t ventricular failure are major determinants of short and long term mortali ty after acute myocardial infarction.