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

August 30, 2011

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.

Related Stories

Recommended for you

Artificial heart design features porous plastic foam

October 2, 2015

Artificial hearts with multiple moving parts increase the chance of failure; scientists have worked up a device which is a single piece. No less interesting is the material they used; the team is taking a page out of soft ...

What powers the pumping heart?

September 25, 2015

Researchers at the Ted Rogers Centre for Heart Research have uncovered a treasure trove of proteins, which hold answers about how our heart pumps—a phenomenon known as contractility.

Sticky gel helps stem cells heal rat hearts

September 24, 2015

A sticky, protein-rich gel created by Johns Hopkins researchers appears to help stem cells stay on or in rat hearts and restore their metabolism after transplantation, improving cardiac function after simulated heart attacks, ...


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.