In:
Circulation: Cardiovascular Quality and Outcomes, Ovid Technologies (Wolters Kluwer Health), Vol. 2, No. 4 ( 2009-07), p. 313-319
Abstract:
Background— No data exist regarding time trends of 28-day case fatality (CF) of patients with presumed acute myocardial infarction (AMI) using epidemiological criteria, clinical criteria, and AMI classification after validation of presumed in-hospital AMI-related deaths (gold-standard criteria). Methods and Results— From 1985 to 2004, we prospectively examined all 9210 AMI patients consecutively hospitalized in a large teaching hospital by using a broad epidemiological AMI definition (WHO-MONICA). Twenty-eight-day CF decreased significantly from 32% in 1985–1986 to 18% in 2003–2004, mostly because of a reduction in early deaths ( 〈 24 hours). When applying the clinical AMI definition, most of the early deaths were not counted as AMI related. A retrospective validation process from a sample of all early deceased patients by the epidemiological AMI definition (388/2076) and a prospective validation of the complete cohort in 2005–2006 revealed that only about 50% of early deaths are reclassified as a real fatal AMI using newer criteria resulting in a 28-day CF of 23% in 1985–1986 and 11% in 2005–2006. The difference between the AMI 28-day CF by applying gold-standard criteria and the clinical AMI 28-day CF (18% in 1985–1986 and 7% in 2005–2006) has decreased during recent years. Conclusions— The application of broad epidemiological criteria for AMI overestimates 28-day CF by almost 2-fold compared with gold-standard criteria (after validation of early deaths) and almost 3-fold compared to the clinical definition. The growing similarity in 28-day CF between the clinically based definition and the gold-standard criteria implies that recent clinical-based registries may represent a realistic picture of trends regarding in-hospital AMI mortality.
Type of Medium:
Online Resource
ISSN:
1941-7713
,
1941-7705
DOI:
10.1161/CIRCOUTCOMES.108.831529
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2009
detail.hit.zdb_id:
2453882-6
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