Key result
Suspected AMI hospitalization is linked to ~32% higher 10-year mortality vs matched controls.
Why the study?
The very long term prognosis after hospitalization for chest pain or symptoms suspicious of AMI in relation to final hospital diagnosis and compared to matched controls was not well described.
Cohort (n=6,324)
No
Patients discharged after hospitalization for suspected AMI have a significantly higher 10-year mortality compared to matched controls, with the risk strongly stratified by the final discharge diagnosis.
Answers are grounded in this paper and cite their sources.
Supports closer long-term monitoring after suspected AMI discharge; leaves open whether diagnosis-specific strategies alter outcomes.
AIM: To describe the 10-year prognosis for patients discharged after hospitalization for chest pain or other symptoms giving an initial suspicion of acute myocardial infarction (AMI) in relation to the final hospital diagnosis and furthermore to compare the outcome amongst these patients with the outcome amongst a sex-, age- and community-matched control population. METHODS: All patients who were hospitalized because of chest pain or other symptoms raising a suspicion of AMI and who were discharged alive from hospital. Patients were divided into three groups according to the final diagnosis: (1) confirmed or possible AMI, (2) confirmed or possible myocardial ischaemia and (3) other aetiology. Information on 10-year mortality was available in 3103 patients. A sex-, age- and community-matched control population (n=3221) was compared with the study population in terms of 10-year mortality. TIME OF SURVEY: 15 February 1986 to 9 November 1987. SETTING: Sahlgrenska University Hospital. RESULTS: Patients with confirmed or possible AMI (n=849) had a significantly higher mortality (59.4%) than patients with confirmed or possible myocardial ischaemia (n=1191) who had a mortality of 49.5% (P < 0.0001). The latter group had a higher mortality than patients with 'other aetiology' (n=1063) of whom 40.6% died (P < 0.0001). When comparing the prognosis for patients with AMI and myocardial ischaemia, there was a significant interaction with sex, with a more marked difference in women than in men. Amongst all patients, the 10-year mortality was 49.1 vs. 37.3% in the control group (P < 0.0001). CONCLUSION: The very long term prognosis was strongly associated with diagnosis amongst patients hospitalized and discharged alive because of chest pain or other symptoms raising suspicion of AMI. The absolute mortality difference between patients who were discharged from hospital with confirmed diagnosis of AMI and those whose symptoms were considered to have other aetiology than AMI or ischaemia was nearly 20%. However, the absolute mortality difference between the patients included in the survey and a control population was only 12%.
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Herlitz et al. (2002) conducted a cohort in chest pain or other symptoms raising suspicion of acute myocardial infarction (n=6,324). Hospitalization for suspected acute myocardial infarction vs. Matched control population was evaluated on 10-year mortality (p=< 0.0001). Hospitalization for suspected acute myocardial infarction was associated with higher 10-year mortality compared to a matched control population.
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