10-YEAR MORTALITY-RATE AFTER DEVELOPMENT OF ACUTE MYOCARDIAL-INFARCTION IN RELATION TO CLINICAL HISTORY AND OBSERVATIONS DURING HOSPITAL STAY - EXPERIENCE FROM THE GOTEBORG METOPROLOL TRIAL

Background: Previous studies on the prognosis after acute myocardial infarction (AMI) have mainly focused on the first few years. In this study, we aimed to describe the mortality rate during 10 years of follow-up after development of AMI in relation to clinical history and observations during the hospital stay. Methods: We prospectively followed for 10 years all patients with suspected AMI, enrolled between 1976 and 1981, participating in an early intervention trial with metoprolol who fulfilled given criteria for AMI. Results: A total of 809 patients developed AMI during the first 3 days in hospital, of whom 399 were randomly assigned to receive metoprolol and 410 to receive placebo. The overall 10-year mortality rate, including initial in-hospital mortality, was 51%. In a multivariate analysis considering age, sex, history of cardiovascular diseases, estimated infarct size, and the occurrence of various complications during initial hospitalization (i.e. congestive heart failure, severe ventricular arrhythmias, tachycardia, hypotension, high-degree atrioventricular block and severity of pain) the following appeared as independent predictors of death: a history of diabetes mellitus (P<0.001), congestive heart failure during hospitalization (P<0.001), age (P<0.001), and a history of previous myocardial infarction (P<0.001). Conclusion: Independent predictors of death during the first 10 years after AMI were a history of diabetes mellitus, congestive heart failure during hospitalization, age, and previous myocardial infarction.