Prognosis of acute myocardial infarction in the thrombolytic era: medical evaluation is still valuable

Background Modern and sophisticated technology for the management of myocar dial infarction has progressively devalued medical evaluation. Hypothesis: This study was undertaken to assess the importance of the findings of medic al evaluation at hospital presentation, in patients with acute myocardial i nfarction. Methods: Data from 590 thrombolytic- treated myocardial infarcti on patients were analyzed. The patients were grouped according to their cli nical status on arrival at hospital. A modified Forrester classification - subset IT was divided according to the absence (IIa) or presence (IIb) of s ymptoms - was applied. Short- (14 days) and long-term (up to 10 years) surv ival was analyzed and 19 independent variables were included in the multiva riate models. Results: Short-term survival was 95.6% for subset I, 83.3% fo r subset IIa, 60% for subset IIb, 54.6% for subset III, and 34.8% for subse t IV (P < 0.001). By multiple regression analysis, lower clinical subsets ( P < 0.001), fewer coronary arteries with disease (P = 0.006), younger age ( P = 0.014), absence of reinfarction (P = 0.034), longer interval between st reptokinase infusion and coronary arteriography (P = 0.016), and higher lef t ventricular ejection fraction (P = 0.037) demonstrated significant and in dependent correlation with short-term survival. Long-term survival for the total population was 71 +/- 3.6% for subset I, 54.4 +/- 8.5% for subset IIa , 20.8 +/- 9.4% for subset IIb, 54.5 +/- 15% for subset III, and 0% for sub set IV (P < 0.001). Using Cox regression analysis, lower clinical subsets ( P < 0.001), younger age (P <less than> 0.001), higher global left ventricul ar ejection fraction (P < 0.001), and fewer coronary arteries with disease (P = 0.021) correlated independently and significantly with long-term survi val. When excluding data from patients who died before the short-term follo w-up (n = 532), lower clinical subsets remained an important predictor of l ong-term survival (P < 0.001). Conclusion: Clinical classification at hospi tal presentation is a powerful predictor of short- and long-term survival p ost-myocardial infarction. (C) 2001 European Society of Cardiology. All rig hts reserved.