Ten‐year mortality amongst patients with a very small or unconfirmed acute myocardial infarction in relation to clinical history, metabolic screening and signs of myocardial ischaemia

Abstract. Karlson BW, Wiklund O, Hallgren P, Sjölin M, Lindqvist J, Herlitz J (Sahlgrenska University Hospital, Göteborg, Sweden). Ten‐year mortality amongst patients with a very small or unconfirmed acute myocardial infarction in relation to clinical history, metabolic screening and signs of myocardial ischaemia. J Intern Med 2000; 247: 449–456. Aim. To evaluate the long‐term prognosis amongst patients with a very small or unconfirmed acute myocardial infarction (AMI) in relation to clinical history, metabolic screening and signs of myocardial ischaemia at exercise test. Methods. Patients with a very small or unconfirmed AMI, aged < 76 years, were selected and given a clinical evaluation, metabolic screening and checked for ischaemia at an exercise test 4 weeks after admittance. The 10‐year mortality was related to age, sex, clinical history, body weight, serum (S) cholesterol, S‐triglycerides, S‐gammaglutamyltranspeptidase (GT), S‐glucose and various indices of myocardial ischaemia at exercise test. Results. In all, 714 patients participated in the evaluation. The median age was 63 years and 33% were women. The overall 10‐year mortality was 33%. In univariate analysis, the following factors appeared as risk indicators for death: age ( P < 0.0001), a history of previous AMI ( P < 0.0001), angina pectoris ( P < 0.001), diabetes mellitus ( P < 0.0001), congestive heart failure ( P < 0.0001), smoking ( P = 0.030), S‐triglycerides ( P < 0.0001), S‐gamma GT ( P < 0.0001) and S‐glucose ( P < 0.0001). In multivariate analysis, the following remained as independent risk indicators for death: age ( P < 0.0001), S‐gamma GT ( P < 0.0001), previous AMI ( P < 0.0001), smoking ( P < 0.0001) and S‐glucose ( P = 0.010). Conclusion. Amongst patients with a very small or a unconfirmed AMI, factors reflecting their clinical history, including age, a history of AMI and current smoking, as well as factors reflecting their metabolic status, including S‐gamma GT and S‐glucose, were important predictors for the long‐term outcome.