Are There Options to Prevent Early Occurring Deaths in Acute Myocardial Infarction: Prospective Evaluation of All < 24 h In-Hospital Deaths, 2004-2006-The MONICA/KORA Augsburg Infarction Registry

Objectives: To provide valid clinical data of early in-hospital deaths with presumed acute myocardial infarction (AMI) who are often not included in clinical trials or registries. Methods: From August 2004 to August 2006 all patients (age 25-84 years) dying within 24 h after hospitalization in a large tertiary care academic teaching hospital were screened regarding an underlying cardiovascular cause of death. Results: After validation, 79 out of 1,352 patients remained with a final diagnosis of AMI. Sixty-six percent of these experienced prehospital cardiac arrest or shock. In 37% no resuscitation attempts were performed in-hospital, the most common reason being multimorbidity. Only 23% could be transferred to coronary angiography for revascularisation attempts. An independent panel of clinicians judged that only in one patient would another management strategy have been promising. Of interest, 33% of the deceased patients had typical or atypical chest pain the days before the lethal event. Conclusion: A large percentage of AMI patients who died soon after hospitalization were in critical circulatory state directly before hospitalization. In 37%, in-hospital resuscitation attempts were omitted for understandable reasons. Options for improvement in acute care in the investigated setting were not found. However, in one third of the cases earlier preventive measures might have been reasonable. Copyright (C) 2010 S. Karger AG, Base

Prognosis and outcomes of elderly (75–84 years) patients with acute myocardial infarction 1–2 years after the event: AMI-elderly study of the MONICA/KORA myocardial infarction registry

BACKGROUND: With increasing life expectancy the management of acute myocardial infarction (AMI) in patients of an older age is of growing importance. However, long-term data are limited regarding &#39;hard&#39; endpoints and quality of life in unselected elderly patients in &#39;real world&#39; settings. METHODS AND RESULTS: From March 2005 to March 2006 all 75-84-year old patients consecutively hospitalised due to an incident AMI in a large community teaching hospital were analyzed (N=235). Evidence-based therapy included the treatment with aspirin (93%), clopidogrel (65%), betablockers (93%), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (84%), and statins (83%). Percutaneous coronary intervention (PCI) was performed in 45.5% and bypass grafting (CABG) in 10.2%. The 28-day-case fatality was 17.4%. Long-term follow-up was obtained in 95.9% of all hospital survivors at a mean of 18.7 &plusmn; 6.4 months; during this time 19.9% of patients died. After multivariate analysis the only significantly negative predictor for survival and MACCE was diabetes, and the only significantly positive predictor was revascularisation during hospital stay. Patients with PCI/CABG had lower NYHA class (81% vs. 48%; p&lt;0.04). Patients with PCI also had a higher EQ-5D index score (75 &plusmn; 18 vs. 67 &plusmn; 17, p&lt;0.04) compared to patients not receiving PCI. CONCLUSION: The positive long-time effect of revascularisation procedures during hospitalisation, not only on &#39;hard&#39; endpoints but also on functional outcome and quality of life emphasizes that invasive therapies should not be considered less valuable in elderly people and that age alone should not preclude aggressive treatment during AMI

Erfurt male cohort study (ERFORT study): study design and descriptive results

Das Hauptziel der ERFORT-Studie bestand darin, kardiovaskul&auml;re Risikofaktoren, lebensstilabh&auml;ngige Verhaltensweisen und psychosoziale Charakteristika mit Blick auf die gesamt- und todesursachenspezifische Mortalit&auml;t und Morbidit&auml;t zu untersuchen. Der vorliegende Beitrag beschreibt das Studiendesign, Untersuchungsbefunde w&auml;hrend der drei Untersuchungswellen mit Blick auf kardiovaskul&auml;re und psychosoziale Faktoren sowie Ergebnisse zum Mortalit&auml;ts-Follow-up im 30-Jahres-Verlauf. Die ERFORT-Studie ist eine populationsbasierte prospektive Kohortenstudie mit M&auml;nnern mittleren Alters (35&ndash;61&nbsp;Jahre) zum Zeitpunkt des Baselinesurveys in den Jahren 1973&ndash;1975. 1160&nbsp;M&auml;nner (74,6% der Zufallsstichprobe von 1600&nbsp;M&auml;nnern) wurden f&uuml;r diese Studie rekrutiert. Nach dem Baselinesurvey gab es im Abstand von jeweils etwa 5&nbsp;Jahren weitere drei Untersuchungswellen. Die gesamte Kohorte wurde bis zum Jahr 2003 im Hinblick auf den Lebensstatus weiter verfolgt. W&auml;hrend des 15-j&auml;hrigen Follow-up-Programms verdoppelten sich etwa die H&auml;ufigkeiten f&uuml;r kardiovaskul&auml;re Erkrankungen wie Myokardinfarkt, Angina pectoris, Claudicatio intermittens. Die Diabetespr&auml;valenz stieg von 2,8% auf 12% im 15-Jahres-Follow-up. Die Pr&auml;valenz hoher Blutdruckwerte (&ge;&thinsp;160/95&nbsp;mmHg) nahm lediglich leicht zu, wobei die antihypertensive Behandlungsrate im 15-Jahres-Zeitraum von 8,7% auf 33,6% anstieg. Rauchen und Diabetes wurden als starke Risikofaktoren f&uuml;r Neuerkrankungen an Claudicatio intermittens w&auml;hrend des 15-j&auml;hrigen Follow-up-Zeitraums identifiziert. Erh&ouml;hte Plasmaglukosewerte nach Glukosebelastung zeigten sich als starker Langzeitpr&auml;diktor f&uuml;r die Gesamtsterblichkeit. Die ERFORT-Studie erlaubte es auch, die Schwankung des Relativgewichtes &uuml;ber einen Zeitraum von 15&nbsp;Jahren mit Blick auf die weitere Mortalit&auml;t im Verlauf von weiteren 15&nbsp;Jahren zu untersuchen. Dabei zeigte sich, dass die Fluktuation des Gewichtes ein st&auml;rkerer Risikofaktor f&uuml;r die Gesamtsterblichkeit ist als ein stabiles &Uuml;bergewicht. Die ERFORT-Studie zeigt als eine der fr&uuml;hesten epidemiologischen Kohorten-Studien in Deutschland nach dem Zweiten Weltkrieg, dass international eingef&uuml;hrte epidemiologische Untersuchungsmethoden in Deutschland etabliert werden k&ouml;nnen und dass Langzeitbeobachtungen zum Lebensstatus m&ouml;glich sind

Extent of the decrease of 28-day case fatality of hospitalized patients with acute myocardial infarction over 22 years

BACKGROUND: No data exist regarding time trends of 28-day case fatality (CF) of patients with presumed acute myocardial infarction (AMI) using epidemiological criteria, clinical criteria, and AMI classification after validation of presumed in-hospital AMI-related deaths (gold-standard criteria). METHODS AND RESULTS: From 1985 to 2004, we prospectively examined all 9210 AMI patients consecutively hospitalized in a large teaching hospital by using a broad epidemiological AMI definition (WHO-MONICA). Twenty-eight-day CF decreased significantly from 32% in 1985-1986 to 18% in 2003-2004, mostly because of a reduction in early deaths (&lt;24 hours). When applying the clinical AMI definition, most of the early deaths were not counted as AMI related. A retrospective validation process from a sample of all early deceased patients by the epidemiological AMI definition (388/2076) and a prospective validation of the complete cohort in 2005-2006 revealed that only about 50% of early deaths are reclassified as a real fatal AMI using newer criteria resulting in a 28-day CF of 23% in 1985-1986 and 11% in 2005-2006. The difference between the AMI 28-day CF by applying gold-standard criteria and the clinical AMI 28-day CF (18% in 1985-1986 and 7% in 2005-2006) has decreased during recent years. CONCLUSIONS: The application of broad epidemiological criteria for AMI overestimates 28-day CF by almost 2-fold compared with gold-standard criteria (after validation of early deaths) and almost 3-fold compared to the clinical definition. The growing similarity in 28-day CF between the clinically based definition and the gold-standard criteria implies that recent clinical-based registries may represent a realistic picture of trends regarding in-hospital AMI mortality

Effect of blood glucose concentrations on admission in non-diabetic versus diabetic patients with first acute myocardial infarction on short- and long-term mortality (from the MONICA/KORA Augsburg myocardial infarction registry)

The aim of this study was to investigate the association between increased admission glucose in nondiabetic (ND) patients and in patients with type 2 diabetes mellitus (T2DM) with first acute myocardial infarctions (AMIs) and 28-day as well as 1- and 3-year case fatality. The Monitoring Trends and Determinants in Cardiovascular Disease (MONICA)/Cooperative Health Research in the Region of Augsburg (KORA) myocardial infarction registry database in Augsburg, Germany, was used, and 1,631 patients without and 659 patients with T2DM (aged 25 to 74 years) who were admitted from 1998 to 2003 with first AMIs were included. Mortality follow-up was carried out in 2005. ND patients with AMIs with admission glucose &gt;152 mg/dl (top quartile) compared with those in the bottom quartile had an odds ratio of 2.82 (95% confidence interval [CI] 1.30 to 6.12) for death within 28 days after multivariate adjustment; correspondingly, patients with T2DM with admission glucose &gt;278 mg/dl (top quartile) compared with those in the bottom quartile (&lt;152 mg/dl) showed a nonsignificantly increased odds ratio of 1.45 (95% CI 0.64 to 3.31). After the exclusion of patients who died within 28 days, a nonsignificantly increased relative risk (RR) was seen between admission blood glucose and 1-year mortality in ND subjects (RR 2.71, 95% CI 0.90 to 8.15), whereas no increased RR was found in subjects with diabetes (RR 0.99, 95% CI 0.34 to 2.82). After 3 years, there was no increased risk for death in patients with high admission blood glucose levels, neither for ND patients nor for those with T2DM. In conclusion, elevated admission blood glucose is associated with increased short-term mortality risk in patients with AMIs, particularly in ND subjects. These patients constitute a high-risk group needing aggressive, comprehensive polypharmacotherapy