Trends in In-Hospital Mortality and Six-Month Outcomes in Patients With a First Acute Myocardial Infarction. Change Over the Last Decade

Treatment of acute myocardial infarction (AMI) has changed considerably in recent years. The objective of this study was to investigate differences in in-hospital mortality and 6-month outcomes after a first AMI between patients who participated in two trials, in 1992-1994 and 2001-2003, respectively.The study involved 1440 consecutive patients with a first AMI who were admitted to four university hospitals during 1992-1994 (the RESCATE-I trial) and 1288 with a first AMI who met the same diagnostic criteria and who were admitted to the same hospitals during 2001-2003 (the RESCATE-II trial). Patient management, in-hospital mortality and 6-month prognosis and outcomes were compared between the two trials.Reperfusion therapy was carried out in 60.7% of patients in the first trial and in 72.6% in the second (P.001). In the RESCATE-II trial, the median door-to-needle time was shorter (41 min vs. 93 min; P.001) and patients more frequently underwent coronary angiography (65.2% vs. 28.1%; P.001) and revascularization (34.9% vs. 8.1%; P.001). In addition, in-hospital mortality was lower in RESCATE-II (7.5% vs. 10.9%; P.001). After adjustment for age, sex, comorbidity, AMI severity and reperfusion therapy, the odds ratio for in-hospital mortality in RESCATE-II compared with the first trial was 0.52 (95% confidence interval, 0.31-0.86). In addition, mortality (1.4% vs. 3.6%; P=.001) and readmissions at 6 months were also lower in RESCATE-II.Both in-hospital and 6-month mortality in patients with a first AMI decreased during the last decade, probably due to more frequent reperfusion and revascularization therapy and better medical treatment.