Advertisement
ADVANCED SEARCH

This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tu, J. V. Articles by Austin, P. Search for Related Content PubMed PubMed Citation Articles by Tu, J. V. Articles by Austin, P. Related Collections Vascular surgery Ischemic heart disease Other epidemiology Cardiothoracic surgery

Temporal changes in the outcomes of acute myocardial infarction in Ontario, 1992-1996

Jack V. Tu, MD, PhD^*, C. David Naylor, MD, DPhil^* and Peter Austin, PhD^*

From *the Institute for Clinical Evaluative Sciences; the Division of General Internal Medicine, Clinical Epidemiology Unit and Health Care Research Program, Sunnybrook Health Science Centre; the Departments of Medicine and Public Health Sciences, and the Department of Public Health Sciences, the University of Toronto, Toronto, Ont.

Abstract

Background: There is relatively little information available on recent population-based trends in the outcomes of patients who have had an acute myocardial infarction (AMI). We, therefore, conducted a study of temporal trends in the outcomes of AMI patients in Ontario, Canada, between the 1992 and 1996 fiscal years.

Methods: 114 618 AMI patients were discharged from hospitals in Ontario between Apr. 1, 1992, and Mar. 31, 1997. After specific exclusion criteria were applied the final sample of 89 456 patients was divided into 5 cohorts according to the fiscal year of discharge. As part of the Ontario Myocardial Infarction Database project the linked administrative data pertaining to these patients were used to examine cohort characteristics, cardiac procedures used and mortality rates for each of the 5 cohorts over time.

Results: There was a significant increase in the percentage of patients in Ontario receiving coronary angiography, percutaneous transluminal coronary angioplasty and coronary artery bypass grafting surgery (p < 0.001) after an AMI between 1992 and 1996. In addition, the overall 30-day risk-adjusted mortality rate declined from 15.5% in 1992 to 14.0% in 1996 (p = 0.001) and the 1-year risk-adjusted mortality rate declined from 23.7% in 1992 to 22.3% in 1996 (p = 0.017). Virtually all of the improvement occurred within 30 days of admission. The absolute decline in 1-year mortality rates was significant for patients under the age of 65 (2.3%, 95% confidence interval [CI] 1.4% to 3.2%) and for males (1.2%, 95% CI 0.2% to 2.2%); absolute declines were not significant for patients 65 years of age or older (0.7%, 95% CI-0.6% to 2.0%) and for female patients (-0.1%, 95% CI -1.7% to 1.5%). Interestingly, post-infarction coronary angiography and coronary artery bypass grafting rates were consistently lower in the older and the female patients throughout the study period.

Interpretation: There was a modest improvement in the short- and long-term survival of patients in Ontario after an AMI between 1992 and 1996. The Ontario experience suggests that recent advances in AMI management have been of more benefit to younger and male AMI patients.

This article has been cited by other articles:

				P. C. Austin PhD, J. V. Tu MD PhD, D. T. Ko MD MSc, and D. A. Alter MD PhD Use of evidence-based therapies after discharge among elderly patients with acute myocardial infarction Can. Med. Assoc. J., October 21, 2008; 179(9): 895 - 900. [Abstract] [Full Text] [PDF]

				P. C. Austin PhD, J. V. Tu MD PhD, D. T. Ko MD MSc, and D. A. Alter MD PhD Factors associated with the use of evidence-based therapies after discharge among elderly patients with myocardial infarction Can. Med. Assoc. J., October 21, 2008; 179(9): 901 - 908. [Abstract] [Full Text] [PDF]

				L. Pilote MD PhD, M. Abrahamowicz PhD, M. Eisenberg MD MPH, K. Humphries DSc, H. Behlouli MSc PhD, and J. V. Tu MD PhD Effect of different angiotensin-converting-enzyme inhibitors on mortality among elderly patients with congestive heart failure Can. Med. Assoc. J., May 6, 2008; 178(10): 1303 - 1311. [Abstract] [Full Text] [PDF]

				S. Setoguchi, R. J. Glynn, J. Avorn, M. A. Mittleman, R. Levin, and W. C. Winkelmayer Improvements in Long-Term Mortality After Myocardial Infarction and Increased Use of Cardiovascular Drugs After Discharge: A 10-Year Trend Analysis J. Am. Coll. Cardiol., April 1, 2008; 51(13): 1247 - 1254. [Abstract] [Full Text] [PDF]

				W. E. Boden and D. J. Maron Reducing Post-Myocardial Infarction Mortality in the Elderly: The Power and Promise of Secondary Prevention J. Am. Coll. Cardiol., April 1, 2008; 51(13): 1255 - 1257. [Full Text] [PDF]

				C. van Walraven, N. Oake, P. S. Wells, and A. J. Forster Burden of Potentially Avoidable Anticoagulant-Associated Hemorrhagic and Thromobembolic Events in the Elderly Chest, May 1, 2007; 131(5): 1508 - 1515. [Abstract] [Full Text] [PDF]

				S. M. Singh, P. C. Austin, A. Chong, and D. A. Alter Coronary Angiography Following Acute Myocardial Infarction in Ontario, Canada Arch Intern Med, April 23, 2007; 167(8): 808 - 813. [Abstract] [Full Text] [PDF]

				B. R. Hemmelgarn, B. J. Manns, J. Zhang, M. Tonelli, S. Klarenbach, M. Walsh, B. F. Culleton, and for the Alberta Kidney Disease Network Association between Multidisciplinary Care and Survival for Elderly Patients with Chronic Kidney Disease J. Am. Soc. Nephrol., March 1, 2007; 18(3): 993 - 999. [Abstract] [Full Text] [PDF]

				B. F. Culleton, B. J. Manns, J. Zhang, M. Tonelli, S. Klarenbach, and B. R. Hemmelgarn Impact of anemia on hospitalization and mortality in older adults Blood, May 15, 2006; 107(10): 3841 - 3846. [Abstract] [Full Text] [PDF]

				G. L. Booth, M. K. Kapral, K. Fung, and J. V. Tu Recent Trends in Cardiovascular Complications Among Men and Women With and Without Diabetes Diabetes Care, January 1, 2006; 29(1): 32 - 37. [Abstract] [Full Text] [PDF]

				S P Johnsen, J Videbaek, L Pedersen, R Steffensen, R Videbaek, T Niemann, T T Nielsen, and H T Sorensen Survival trends among Danish patients undergoing coronary angiography for known or suspected ischaemic heart disease: a population based follow up study, 1992-2000 Heart, January 1, 2006; 92(1): 27 - 31. [Abstract] [Full Text] [PDF]

				Z. Zhou, E. Rahme, M. Abrahamowicz, J. V. Tu, M. J. Eisenberg, K. Humphries, P. C. Austin, and L. Pilote Effectiveness of statins for secondary prevention in elderly patients after acute myocardial infarction: an evaluation of class effect Can. Med. Assoc. J., April 26, 2005; 172(9): 1187 - 1194. [Abstract] [Full Text] [PDF]

				D. T. Ko, P. C. Austin, B. T. B. Chan, and J. V. Tu Quality of Care of International and Canadian Medical Graduates in Acute Myocardial Infarction Arch Intern Med, February 28, 2005; 165(4): 458 - 463. [Abstract] [Full Text] [PDF]

				D. T. Ko, M. Mamdani, and D. A. Alter Lipid-Lowering Therapy With Statins in High-Risk Elderly Patients: The Treatment-Risk Paradox JAMA, April 21, 2004; 291(15): 1864 - 1870. [Abstract] [Full Text] [PDF]

				W.-C. Chang, P. Kaul, C. M. Westerhout, M. M. Graham, Y. Fu, T. Chowdhury, and P. W. Armstrong Impact of Sex on Long-term Mortality From Acute Myocardial Infarction vs Unstable Angina Arch Intern Med, November 10, 2003; 163(20): 2476 - 2484. [Abstract] [Full Text] [PDF]

				J. V. TU and C. CAMERON Impact of an acute myocardial infarction report card in Ontario, Canada Int. J. Qual. Health Care, March 1, 2003; 15(2): 131 - 137. [Abstract] [Full Text] [PDF]

				D. A. Alter, C. D. Naylor, P. C. Austin, B. T.B. Chan, and J. V. Tu Geography and service supply do not explain socioeconomic gradients in angiography use after acute myocardial infarction Can. Med. Assoc. J., February 4, 2003; 168(3): 261 - 264. [Abstract] [Full Text] [PDF]

				D. A. Alter, C. D. Naylor, P. C. Austin, and J. V. Tu Biology or bias: practice patterns and long-term outcomes for men and women with acute myocardial infarction J. Am. Coll. Cardiol., June 19, 2002; 39(12): 1909 - 1916. [Abstract] [Full Text] [PDF]

				P. C. Austin A Comparison of Bayesian Methods for Profiling Hospital Performance Med Decis Making, April 1, 2002; 22(2): 163 - 172. [Abstract] [PDF]

				J. V. Tu, P. C. Austin, and B. T. B. Chan Relationship Between Annual Volume of Patients Treated by Admitting Physician and Mortality After Acute Myocardial Infarction JAMA, June 27, 2001; 285(24): 3116 - 3122. [Abstract] [Full Text] [PDF]

				D. A. Alter, C. D. Naylor, P. C. Austin, and J. V. Tu Long-term MI Outcomes at Hospitals With or Without On-site Revascularization JAMA, April 25, 2001; 285(16): 2101 - 2108. [Abstract] [Full Text] [PDF]

				J. V. Tu, P. C. Austin, R. Walld, L. Roos, J. Agras, and K. M. McDonald Development and validation of the ontario acute myocardial infarction mortality prediction rules J. Am. Coll. Cardiol., March 15, 2001; 37(4): 992 - 997. [Abstract] [Full Text] [PDF]

				C. A. Jackevicius, G. M. Anderson, L. Leiter, and J. V. Tu Use of the Statins in Patients After Acute Myocardial Infarction: Does Evidence Change Practice? Arch Intern Med, January 22, 2001; 161(2): 183 - 188. [Abstract] [Full Text] [PDF]

				L. Pilote, F. Lavoie, V. Ho, and M. J. Eisenberg Changes in the treatment and outcomes of acute myocardial infarction in Quebec, 1988-1995 Can. Med. Assoc. J., July 1, 2000; 163(1): 31 - 36. [Abstract] [Full Text] [PDF]

HOME	CURRENT ISSUE	PAST ISSUES	COLLECTIONS	HELP	SEARCH
Copyright 1995-1999, Canadian Medical Association. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p) All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.