Abstract 2858: Increase of Post-Discharge Mortality of Patients with Acute Myocardial Infarction in New Jersey: 1986–2002
Background. The in-hospital mortality of acute myocardial infarction (MI) has decreased markedly in the last two decades. However, the prognosis of MI patients who are discharged alive has not been studied well.
Methods. Using the Myocardial Infarction Data Acquisition System (MIDAS) database we studied the in-hospital and one year post discharge mortality of patients admitted with a first acute MI in New Jersey from 1986 to 2002 (n=247,615).
Results. Between 1986 and 2002, in-hospital mortality decreased from 15.8% to 9.0% (p<0.0001). This was especially pronounced among younger patients with Q-wave infarction (adjusted OR 0.64, CI 0.48–0.86). Contrary to the decrease of in-hospital mortality, patients discharged alive experienced increased (11.2% to 14.4%) one-year post discharge mortality (1986 vs. 2002, OR 1.15, 1.07–1.25 adjusted for gender, age, co-morbidities, complications, MI type, hospital type, insurance and geographic setting). This increase in mortality was more pronounced in the older age groups (adjusted OR 1.20, CI 1.17–1.23). Among patients discharged alive, one-year post discharge mortality was higher (p<0.05) among men, older patients and those with co-morbidities or complications and lower among those who had coronary interventions (OR 0.48, 0.47–0.50). The rate of use of coronary interventions increased markedly among patients with Q-MI (from 7.0% in 1986 to 62.9% in 2002 vs. for non-Q MI 8.2% to 39.0%) and in younger patients (10.3%–66.4% vs. 1.8%–29.2% for those over 75 years of age).
Conclusions. Contrary to the marked decrease of in-hospital mortality, post discharge mortality of MI survivors has increased especially among older patients. These patients also have lower rates of use of interventional cardiac procedures.