Skip Navigation

European Heart Journal 2002 23(9):714-720; doi:10.1053/euhj.2001.2947
Copyright © 2002 by the European Society of Cardiology.
This Article
Right arrow Full Text (PDF)
Right arrow References
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (18)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Kuch, B.
Right arrow Articles by Loewel, H.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Kuch, B.
Right arrow Articles by Loewel, H.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

What is the real hospital mortality from acute myocardial infarction?. Epidemiological vs clinical view

B. Kucha,f1, H.-D. Boltea, A. Hoermannb, C. Meisingerc and H. Loewelc

a I. Med. Klinik, Klinikum Augsburg, Lehrkrankenhaus der Ludwig Maximilians Universität München, GSF-Institute of Epidemiology
c GSF-Institute of Epidemiology, Neuherberg, Germany
b GSF-Medis Institute, Neuherberg, Germany

Received May 8, 2001; accepted July 25, 2001

Abstract

Aims To examine the general influence of the definition of fatal and non-fatal acute myocardial infarction and coronary deaths on the estimation of in-hospital case-fatality, and to show how the definition of acute myocardial infarction influences time-trends of hospital mortality over 11 years.

Methods and Results As part of the World Health Organization's MONICA (multinational Monitoring of Trends and Determinants in Cardiovascular Disease) Project in Augsburg all patients aged 25–74 years with a suspected diagnosis of acute myocardial infarction who were hospitalized in the study region's major clinic were registered prospectively between 1985 to 1995 (n=4889). Patient information, including short-term survival status, was obtained from medical records, by interview of surviving patients, and municipal death certificate files which were validated by an extended identification and validation process. In-hospital case fatality was estimated according to different definitions which closely followed the international MONICA criteria. Epidemiological definitions comprised definite and possible acute myocardial infarction, and events with unclassifiable deaths, while the clinical definition was restricted to definite infarction. Overall, case fatality by the epidemiological definitions was 28 to 29·8% (23·5% of those treated in a coronary care unit) compared to 13·5% using the clinical definition. While over the 11 years, the reduction in case fatality according to the epidemiological definitions was modest, highly significant decreases were observed by applying the clinical definition (from 15·8% in 1985–1988 to 10·8% in 1993–1995, P<0·001 adjusted for age and sex). The discrepancy in case fatality between the definitions is explained by the high proportion of patients who die very early (about 70% of all fatal events during the first 24h) with the consequence of missing data which may preclude a definite diagnosis of acute myocardial infarction.

Conclusions Applying a broader definition of acute myocardial infarction reveals that in-hospital mortality is higher than believed until now, and it implies that our efforts must be intensified to reduce overall in-hospital coronary heart disease mortality.

Key Words: Myocardial infarction, hospital mortality, AMI definition, epidemiology

f1 Correspondence: Bernhard Kuch, MD, I. Medizinische Klinik, Klinikum Augsburg, Stenglingstr. 2, 86 156 Augsburg, Germany.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 CMAJHome page
G. Yuan, J. Wang, and R. A. Hegele
Heterozygous familial hypercholesterolemia: an underrecognized cause of early cardiovascular disease.
Can. Med. Assoc. J., April 11, 2006; 174(8): 1124 - 1129.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
C. Meisinger, H. Loewel, W. Mraz, and W. Koenig
Prognostic value of apolipoprotein B and A-I in the prediction of myocardial infarction in middle-aged men and women: results from the MONICA/KORA Augsburg cohort study
Eur. Heart J., February 1, 2005; 26(3): 271 - 278.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
V. Salomaa, M. Ketonen, H. Koukkunen, P. Immonen-Raiha, T. Jerkkola, P. Karja-Koskenkari, M. Mahonen, M. Niemela, K. Kuulasmaa, P. Palomaki, et al.
Decline in Out-of-Hospital Coronary Heart Disease Deaths Has Contributed the Main Part to the Overall Decline in Coronary Heart Disease Mortality Rates Among Persons 35 to 64 Years of Age in Finland: The FINAMI Study
Circulation, August 12, 2003; 108(6): 691 - 696.
[Abstract] [Full Text] [PDF]

Home page
 JWatch Emergency Med.Home page
What Is the Real Rate for AMI?
Journal Watch Emergency Medicine, August 14, 2002; 2002(814): 7 - 7.
[Full Text]


Disclaimer:
Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.