Changes in mortality of acute myocardial infarction as a function of a changing treatment during the last two decades

Forty years ago, after the establishment of coronary care units, a signific ant decrease in mortality of acute myocardial infarction was noted. Twenty years ago, the breakthrough of thrombolysis realized once again a significa nt decrease in mortality. In this study we compare, in a rather small commu nity hospital, the mortality and safety of thrombolytic therapy in acute my ocardial infarction with a more conventional, conservative medical therapy. We examined all cases of acute myocardial infarction between 1978 up to 199 8 inclusive, concerning treatment and mortality rate after a six month peri od. To be included in the study, acute myocardial infarction had to fulfill particular inclusion criteria. A total of 1863 cases of acute myocardial i nfarction were included. The mortality rate of patients with acute myocardial infarction treated wit h thrombolytic agents was strikingly lower and statistically very significa ntly different (p < 0.001) in comparison with the mortality rate of patient s treated with heparin or coumarine derivatives. The mortality rate dropped from 10.57% in the coumarine group and from 14.9 5% in the heparin group to 5.41% in the alteplase group, to 4.95% in the an istreplase group and 4.00% in the streptokinase subgroup. The complications directly connected to the treatment did not seem to be di fferent between the five groups, and they were also not more frequent by us ing thrombolytic agents. In the last 20 years, better preventive measures (life habits, diet, medica tion) and trials to better control the risk factors have not influenced gre atly the average amount of cholesterol in patients with an acute myocardial infarction, Also the percentage of patients with high blood pressure has h ardly decreased over the last 20 years. The mortality associated with acute myocardial infarction has decreased sig nificantly with the use of thrombolytics. In most cases, thrombolytics are administered routinely and safely. In this way, they are the first choice t herapy for myocardial infarction in smaller hospitals. To obtain excellent coronary patency, thrombolytic agents with a long half- life and with PAI-1 resistance are required in the future. The current measures and medical therapies seem to be insufficient to contr ol the risk factors for coronary atherosclerosis.