Abstract 2390: Changes in Post Discharge Outcome of Acute Myocardial Infarction in a Statewide Database
Background. During the last two decades, the in-hospital case-fatality of Acute Myocardial Infarction (AMI) has decreased considerably. However, investigators have not focused on the post discharge outcome of AMI patients.
Methods. We used the Myocardial Infarction Data Acquisition System (MIDAS), a New Jersey statewide database, to examine the post discharge outcome among 182,274 patients who were discharged alive after an MI between 1990 to 2004.
Results. Within one year after patient discharge, the rate of recurrent infarction (REMI) decreased slightly (8.4% to 7.5%, p<.0001) but the rate of death increased (8.4% to 11.6%, p<.0001) from year 1990 to 2004. Cardiovascular death rate increased by 17% while the increase in non cardiovascular death was more pronounced (91%). The rate of either REMI or death increased from 16.8% in 1990 to 19.1% in 2004 (p<.0001). Almost 50% of REMI (49.4% in 1990, 44.8% in 2004) and death (42.2% in 1990, 47.2% in 2002) at 1 year post discharge occurred within 60 days after discharge. Patients who suffered REMI or death were older (death 76, REMI 71 compared to 63 years for those without either), and more likely to have diabetes (adjusted OR: 1.38, p<.0001), renal disease (AOR: 1.86, p<.0001), anemia (AOR: 1.22, p<.0001), cancer (AOR: 3.03, p<.0001), cerebrovascular disease (AOR: 1.51, p<.0001) and a non-Q wave MI in their first admission (AOR: 1.18, p<.0001).
Conclusions. Contrary to the widely-known decrease in in-hospital case-fatality in the last 15 years, there has been a large increase in post discharge REMI and death. This is partially due to older age and higher rate of co-morbidities but the worse prognosis in recent years remains in part unexplained.