What do patients receiving optimal medical therapy after a heart attack die from?

Because of improved management at the acute stage, the risk of dying in hospital after a heart attack has decreased by about 50% in the past 10 years. Likewise, the prescription of recommended medications when patients leave hospital, has resulted in improved survival and fewer recurrent heart attacks. One of the challenges is now to try and further decrease long-term mortality in patients who leave the hospital on "optimal" medical therapy (i.e. who are prescribed all the recommended medications).

The French registry of Acute ST-elevation and non-ST-elevation (FAST-MI) is a nationwide survey of patients hospitalised for in France at the end of 2005, during a one-month period. Patients included will be followed for a period of 10 years after the initial heart attack. At three years, fewer than 5% of the patients have been lost to follow-up.

Of a population of 3,670 patients included in the registry, 3,262 survived the initial hospitalization and had a complete prescription at discharge available. Among them, 1586 (49%) received optimal treatment (OMT).

Three-year survival was 88% in optimally treated patients, compared with 77.5% in those who did not receive all recommended medications. After taking into account the initial profile of the patients and the severity of the heart attack, there was an 18% reduction in the risk of dying in patients receiving optimal .

Analysis of the factors related with 3-year mortality in patients who received optimal treatment showed that the risk of death was related to older age (> 75 years), severity of the (larger infarction, more extensive disease of the coronary artery), associated conditions, such as diabetes mellitus, stroke, cancer or persistent smoking; in contrast, patients who had had a during the initial hospitalization had a markedly reduced risk of dying.

These findings suggest that there is still room for improvement in patients who receive the best possible medical treatment; of these patients, 12% still die during the 3 years that follow the initial .

A broader use of coronary angiography and myocardial revascularization during the initial hospitalisation is likely to have a favorable influence on long-term outcomes. In addition, additional efforts are needed and should concentrate on better management of larger infarctions to prevent and treat heart failure, and on associated conditions such as diabetes. Persistent smoking should also be fought relentlessly.

add to favorites email to friend print save as pdf

Related Stories

Some heart attack rates declining and survival improving

Jan 12, 2011

Coronary syndromes vary in severity, ranging from unstable angina, non-ST segment elevation myocardial infarction (NSTEMI), to ST-segment elevation myocardial infarction (STEMI), the most severe diagnosis. Little data exist ...

HIV infection appears to increases the risk of heart attack

Apr 24, 2007

Researchers from Massachusetts General Hospital (MGH) have found that infection with HIV, the virus that causes AIDS, is also associated with increased risk of myocardial infarction or heart attack. While rates of several ...

Recommended for you

Study: Removing clot helps limit stroke disability

Dec 17, 2014

For the first time in several decades, a new treatment has been shown to limit the damage from a common type of stroke. Researchers in the Netherlands found that mechanically removing a clot in addition to using a clot-busting ...

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.