Long-term survival and predictors of mortality in Coronat)' Heart Disease

Coronruy heart disease (CHD) is by far the most important cause of death, and a main cause of disability in the Netherlands. Accordingly, coronruy heart disease has a great impact on society. In 1995 cardiac death occurred in about 40,000 persons (28% of all monality) and ischemic heart disease was the reason for 170,000 hospital admissions. I Since the 1980s an inunediate benefit is achieved in patients with acute manifestations of CHD, with pharmacologic therapy such as thrombolytic therapy in patients with evolving myocru·dial infarction and coronary interventions such as coronary aorto bypass graft surgery (CABG) and percutaneous transluminal coronary angioplasty procedure (PTCA). Together with improved secondalY prevention through diet, reduced smoking and medical regimens such as antiplatelets, beta-blockers, ace-inhibitors and statins the life expectancy has been improved. This resulted in an increase of patients with chronic manifestations of CHD including heart failure and a population of survivors with a

Changes in Clinical Profile, Treatment, and Mortality in Patients Hospitalised for Acute Myocardial Infarction between 1985 and 2008

Objectives: To quantify the impact of the implementation of treatment modalities into clinical practice since 1985, on outcome of patients with ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI). Methods: All consecutive patients admitted for STEMI or NSTEMI at the Thoraxcenter between 1985 and 2008 were included. Baseline characteristics, pharmacological and invasive treatment modalities, and survival status were collected. The study population was categorised in three groups of patients: those hospitalised between 1985-1990, 1990-2000, and 2000-2008. Results: We identified 14,434 patients hospitalised for myocardial infarction (MI). Both STEMI and NSTEMI patients were increasingly treated with the current guideline based therapy. In STEMI, at 30 days following admission, cumulative mortality rate decreased from 17% in 1985-1990 to 13% in 1990-2000, and to 6% in 2000-2008. Adjusted 30-day and three-year mortality in the last period was 80% and 68% lower than in 1985, respectively. In NSTEMI, at 30 days following admission, cumulative mortality rate decreased from 6% in 1985-1990 to 4% in 1990-2000, and to 2% in 2000-2008. Adjusted 30-day and three-year mortality in the last period was 78% and 49% lower than in 1985, respectively. For patients admitted between 2000 and 2008, 3 year survival of STEMI and NSTEMI patients was 87% and 88%, respectively. Conclusions: Our results indicate substantial improvements in acute-and long-term survival in patients hospitalised for MI, related to improved acute-as well as long-term treatment. Early medical evaluation in suspected MI and intensive early hospital treatment both remain warranted in the future

Prediction of 8-year cardiovascular outcomes in patients with systemic arterial hypertension: Value of stress Tc-99m-tetrofosmin myocardial perfusion imaging in a high-risk cohort

Systemic arterial hypertension is a strong and prevalent cardiovascular risk factor. Currently, information on the very long-term prognostic value of single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) in patients with systemic arterial hypertension is lacking. The aim of this study was to assess the value of stress Tc-99m-tetrofosmin MPI for the prediction of very long-term outcome in these patients. The study population consisted of 608 patients with systemic arterial hypertension who underwent exercise or dobutamine stress Tc-99m-tetrofosmin MPI for the assessment of known or suspected coronary artery disease. Follow-up was successful in 600 (99%) patients. The endpoints were all-cause mortality, cardiac death, nonfatal infarction, and coronary revascularization. Kaplan-Meier survival cures were constructed and univariate and multivariate analyses were performed to identify predictors of v The mean age of the patients was 59 +/- A 10 years, and 65% of them were male. MPI findings were normal in 301 patients (50%). Myocardial perfusion abnormalities were fixed in 162 (27%) and reversible in 137 (23%) patients. During a median 8.1-year follow-up, 241 (40%) patients died (121 cardiac deaths), 52 (9%) had a nonfatal myocardial infarction, and 128 (21%) underwent coronary revascularization. Survival curves in patients with a low vs a high summed difference score diverged up to 5 years Stress Tc-99m-tetrofosmin MPI provides incremental prognostic information for the prediction of cardiovascular outcome in patients with systemic arterial hypertension. Patients with normal stress MPI have a significantly better prognosis as compared with those with an abnormal study, up to 5 years after the test is performed