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The Underlying Risk of Death After Myocardial Infarction in the Absence of Treatment
Malcolm R. Law, FRCP;
Hilary C. Watt, MSc;
Nicholas J. Wald, FRCP
Arch Intern Med. 2002;162:2405-2410.
Background The underlying risk of death in the absence of treatment after a myocardial infarction (MI) is poorly documented.
Methods Analysis of 23 published studies in which 14 211 patients were followed prospectively after MI; 6817 deaths were recorded. We restricted the analysis to studies in which follow-up was completed by 1980 to quantify the underlying risk in the absence of effective treatments.
Results After a first MI, on average, 23% of patients died before reaching the hospital and another 13% died during hospital admission; these rates increased with age. After hospital discharge cardiovascular mortality was approximately 10% in the first year and 5% per year thereafter, rates that were unrelated to age or sex. The yearly death rate of 5% persisted indefinitely; after 15 years, cumulative cardiovascular mortality was 70%. After a subsequent MI, 33% of patients died before reaching the hospital, and 20% died in hospital. After discharge, cardiovascular mortality was approximately 20% in the first year and 10% per year thereafter, rates again unrelated to age and sex. Approximately a third of all heart disease deaths occurred minutes after the first MI, a sixth during the first hospitalization, and half after a subsequent MI, which could occur many years after the first.
Conclusions In persons with a history of MI, cardiovascular mortality in the absence of treatment is high—5% per year after a first MI and 10% per year after a subsequent MI, persisting for many years and probably for the rest of a person's life. The high mortality rate emphasizes the need to ensure that everyone who has had an MI, even years previously, receives effective preventive treatment.
From the Department of Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, Queen Mary's School of Medicine and Dentistry, University of London, London, England.
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