IMPROVEMENT IN SURVIVAL AFTER MYOCARDIAL-INFARCTION BETWEEN 1978-85 AND 1986-88 IN THE REGICOR STUDY

Aspirin, intranvenous nitrates and fibrinolysis were being used by 1986 in Girona, Spain. These combined factors should be reflected in myocardial infarction patients' outcome. We assessed changes in 28-day and 3-year survival after a first myocardial infarction between 1978-85 and 1986-88 in the REGICOR (Registre Glroni del COR) registry. This included 1216 consecutive patients with a first transmural myocardial infarction (834 in 1978-85 and 372 in 1986-88). Their 28-day and 3-year mortality rates were 14.6% and 8.8% respectively. Although patients admitted in the second period were more frequently hypertensive and diabetic, a history of angina was less common in patients admitted between 1978 and 1985. After adjusting for diabetes, hypertension, age, and sex, the relative risk of 28-day mortality of those admitted in the second period was 0.65 (95% confidence interval 0.42-0.99). The lower severity, as measured by Killip class of patients in the second period, was the main (confounding) variable responsible for this protective effect. Three-year mortality of those surviving 28 days in 1978-85 (8.3%) did not differ from 1986-88 (8.3%). In the second study period hospitalized patients with myocardial infarction in Girona, Spain showed a better 28-day survival. It is possible that therapeutic and diagnostic refinements, together with other factors not controlled in the present study, have resulted in such an improvement. However, 3-year mortality remained unmodified among those surviving 28 days.