Survival prospects after acute myocardial infarction in the UK: a matched cohort study 1987–2011

Lisanne A Gitsels, Elena Kulinskaya, Nicholas Steel

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Objectives: Estimate survival after acute myocardial infarction (AMI) in the general population aged 60 and over, and the effect of recommended treatments.

Design: Cohort study in the United Kingdom with routinely collected data between January 1987 and March 2011.

Setting: 310 general practices that contributed to The Health Improvement Network (THIN) database.

Participants: Four cohorts who reached the age of 60, 65, 70, or 75 years between 1987 and 2011 included 16,744, 43,528, 73,728, and 76,392 participants, respectively. Participants with a history of AMI were matched on sex, year of birth, and general practice to three controls each.

Outcome measures: The hazard of all-cause mortality associated with AMI was calculated by a multilevel Cox’s proportional hazards regression, adjusted for sex, year of birth, socioeconomic status, angina, heart failure, other cardiovascular conditions, chronic kidney disease, diabetes, hypertension, hypercholesterolaemia, alcohol consumption, body mass index, smoking status, coronary revascularisation, prescription of beta blockers, ACE inhibitors, calcium-channel blockers, aspirin, or statins, and general practice.

Results: Compared to no history of AMI by age 60, 65, 70, or 75, having had one AMI was associated with an adjusted hazard of mortality of 1.80 (95% CI 1.60-2.02), 1.71 (1.59-1.84), 1.50 (1.42-1.59), or 1.45 (1.38-1.53), respectively, and having had multiple AMIs with a hazard of 1.92 (1.60-2.29), 1.87 (1.68-2.07), 1.66 (1.53-1.80), or 1.63 (1.51-1.76), respectively. Survival was better after statins (hazard ratio range across the four cohorts 0.74-0.81), beta blockers (0.79-0.85), or coronary revascularisation (in first five years) (0.72-0.80); unchanged after calcium-channel blockers (1.00-1.07); and worse after aspirin (1.05-1.10) or ACE inhibitors (1.10-1.25).

Conclusions: The hazard of death after AMI is less than reported by previous studies, and standard treatments of aspirin or ACE inhibitors prescription may be of little benefit or even cause harm.
Original languageEnglish
Article numbere013570
JournalBMJ Open
Issue number1
Publication statusPublished - 1 Jan 2017

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