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

Hypertrophic cardiomyopathy in a large community-based population: clinical outcome and identification of risk factors for sudden cardiac death and clinical deterioration

AbstractObjectivesThis study evaluates the clinical course and identifies risk factors for sudden cardiac death (SCD) and clinical deterioration in hypertrophic cardiomyopathy (HCM) in a large community-based population. Comparison was made with data from six tertiary referral and six nonreferral institutions.BackgroundHypertrophic cardiomyopathy is a disease with marked heterogeneity in clinical presentation and prognosis. Risk factors for SCD are not well defined in patients free of referral bias.MethodsBetween 1970 and 1999, 225 consecutive patients (mean age [±SD] 41±16 years) were examined and followed at yearly intervals.ResultsForty-four deaths were recorded of which 27 cases were cardiovascular. Fourteen patients died suddenly, six were successfully resuscitated, and seven patients died of congestive heart failure. The annual mortality, annual cardiac mortality, and annual mortality due to sudden death were 1.3%, 0.8%, and 0.6%, respectively. At least one New York Heart Association (NYHA) functional class deterioration was reported in 33% of the patients with a significant (≥50 mm Hg) left ventricular outflow tract (LVOT) gradient in contrast to 7% without obstruction. The presence of syncope was related to SCD (p < 0.05). Younger age and more severe functional limitation distinguishes patients from in hospital-based centers from the ones in community-based centers.ConclusionsHypertrophic cardiomyopathy is a benign disease in an unselected population with a low incidence of cardiac death. Syncope was associated with a higher incidence of SCD and patients with a significant LVOT obstruction were more susceptible to clinical deterioration

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

973-108 Unstable Angina Patients Fare No Worse than Stable Patients Ten Years After Balloon Angioplasty

AimThis study was designed to assess the 10 year clinical status of all 856 patients who underwent percutaneous transluminal coronary angioplasty (PTCA) in the first 5 years of our experience (1980-1985) and compare those with stable (SAP) and unstable angina (UAP).MethodsAll patients were contacted via letter, telephone or family doctor and details of cardiac events (death, infarction, rePTCA, coronary artery surgery) checked against hospital records. Actuarial survival and event-free survival curves were constructed and SAP and UAP patients compared.ResultsThe overall 5 and 10 year actuarial survival was 91% and 79% respectively. The 10 year event-free survival for all patients was 35%. The outcome of SAP and UAP patients are compared and displayed in the table. There is no significant difference in survival or clinical events.ConclusionsTen year survival after PTCA is good although the majority of patients suffer a further cardiac event. There is no significant long-term difference in cardiac events between SAP and UAP patients