Two-year mortality and its determinants following acute myocardial infarction in Trinidad and Tobago

The purpose of this study was to determine the occurrence of coronary arter y disease risk factors in patients presenting with acute myocardial infarct ion (AMI) to a tertiary care institution in Trinidad and to determine the f actors associated with increased mortality following AMI All patients admit ted to the Eric Williams Medical Sciences Complex (EWMSC) between January 1 and December 31, 1996, with a diagnosis of AMI were identified using the h ospital admissions and discharge diagnosis databases. Demographic clinical and laboratory variables were extracted from the hospital case records of p atients with confirmed AMI, Sixty-one AMI patients (38 men) were admitted d uring the study period. Mean age at admission was 60 +/- 11 years with an e thnic case mix of thirty-nine (62%) of East Indian descent, eight (13%) of African descent twelve (20%) mixed ethnicity and three (5%) of Caucasian de scent. Thirty patients (49%) were hypertensive. Thirty-two patients (53%) w ere diabetic and eighteen patients (30%) gave a history of cigarette smokin g. The mean left ventricular ejection fraction was 53 +/- 14%. The mean ser um cholesterol from 29 patients was 228.2 +/- 49.0 mg/dl. Increasing age, f emale gender, an ejection fraction less than 40%, non treatment with strept okinase and in-hospital ventricular fibrillation were associated with poor survival. Multiple regression analyses identified three independent predict ors of mortality. These were gender (p=0.04), in-hospital ventricular fibri llation (p=0.001) and an ejection fraction less than 40% (p=0.02). Diabetes mellitus, hypertension, hyperlipidaemia and cigarette smoking were prevale nt amongst patients presenting with AMI. Ventricular function was a major d eterminant of two-year mortality following AMI. Aggressive risk factor modi fication is, recommended to prevent both first and recurrent coronary event s.