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Early revascularisation and 1-year survival in 14-day survivors of acute myocardial infarction: a prospective cohort study
Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
Department of Cardiology, University Hospital of Uppsala, Uppsala.
2002 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 359, no 9320, 1805-1811 p.Article in journal (Refereed) Published
Abstract [en]


Randomised trials of early revascularisation in acute coronary syndromes have yielded conflicting results with respect to effects on survival. We assessed the association between revascularisation within 14 days after the index event and 1-year mortality in individuals who survived for at least 14 days after an acute myocardial infarction.


We studied a prospective cohort of patients admitted to the coronary care units of 61 Swedish hospitals between 1995 and 1998. We obtained 1-year mortality data from the Swedish National Cause of Death Register. We assessed 21 912 individuals with first registry-recorded acute myocardial infarction, who were younger than age 80 years, and alive at day 14. Relative risk of 1-year mortality in patients who had revascularisation (n=2554) or those who did not (n=19 358) within 14 days was calculated by Cox regression analysis, adjusting for multiple covariates that affect mortality and with a propensity score that adjusted for covariates that affected the likelihood of early revascularisation.


At 1 year, unadjusted mortality was 9·0% (1751 deaths) in the conservative group and 3·3% (84 deaths) in the early revascularisation group. In the Cox regression analysis early revascularisation was associated with a reduction in 1-year mortality (relative risk 0·47; 95% Cl 0·37–0·60; p <0·001). This relative reduction of mortality was similar in all subgroups irrespective of age, sex, baseline characteristics, previous disease manifestations, or treatment.


Early revascularisation in individuals with acute myocardial infarction is associated with substantial reduction in 1-year mortality. Our findings lend support to the use of an invasive approach early after an acute myocardial infarction.

Place, publisher, year, edition, pages
2002. Vol. 359, no 9320, 1805-1811 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-27151DOI: 10.1016/S0140-6736(02)08710-XLocal ID: 11799OAI: diva2:247702
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-19Bibliographically approved
In thesis
1. Improving outcome in acute myocardial infarction
Open this publication in new window or tab >>Improving outcome in acute myocardial infarction
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Despite common guidelines there are vanatlons in the treatment of acute myocardial infarction (AMI) between hospitals in Sweden. Uncertainties remain regarding the efficacy of early statin therapy and early revascularisation in AMI patients. In the elderly patients also the role of fibrinolytic therapy has been questioned.

Methods: We created a national quality assurance register named RIKS-HIA including all patients admitted to participating hospitals' ICCU. The database accumulates information about baseline characteristics, interventions, complications and outcome in consecutive patients. The merging of the database with the Cause of Death Register provides  opportunity to compare the effects of treatments on long-term outcome. Multivariate Cox regression analysis and propensity score was used to evaluate outcome in AMI patients of the studied interventions, and to compare activity level between different hospitals.

Results: After patient characteristics were taken into account there were still significant differences between the hospitals in some treatment modalities that remained over time. There was no correlation between hospital size and activity level. In 19 599 in-hospital survivors after their first registry-recorded AMI at an age below 80 years early statin treatment was associated with a 25 % relative risk reduction of I-year mortality. In 21 912 patients with first registry-recorded AMI younger than 80 years and alive at day 14, early revascularisation was associated with a 50 % relative reduction of I-year mortality. For both therapies the effects were homogeneous among all subgroups based on age, gender, baseline characteristics, previous disease manifestations and medication. Fibrinolytic therapy in ST-segment elevation myocardial infarction patients 75 years of age and older showed a net benefit of 13% in outcome when non-fatal intracranial haemorrhage and I-year survival were analysed.

Conclusion: The results indicates the need of continuous quality assurance, and strategies to reduce the differences in AMI therapy between hospitals. They lend support to early statin and early revascularisation regimens in AMI patients. Fibrinolytic therapy is recommended also in the elderly patients.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2002. 73 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 740
National Category
Medical and Health Sciences
urn:nbn:se:liu:diva-27543 (URN)12202 (Local ID)91-7373-189-7 (ISBN)12202 (Archive number)12202 (OAI)
Public defence
2002-11-07, Elsa Brändströmsalen, Campus US, Linköpings universtiet, Linköping, 13:00 (Swedish)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-19Bibliographically approved

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