Mortality Risk and Patterns of Practice in 2,070 Patients With Acute Myocardial Infarction, 1987-92: Relative Importance of Age, Sex, and Medical Therapy

Objective To define contemporary age- and sex-related mortality risks and patterns of medical practice in acute myocardial infarction (AMI). Design Retrospective comparison of demographic and clinical variables, including the use of proven effective AMI medical therapy, among AMI patient cohorts from 1987 to 1992. Patients/Setting Of a total of 2,070 AMI patients, 629 were women and 1,441, men; 951 patients were managed in university hospitals, 641 in a regional hospital, and 478 in community hospitals. Interventions No direct study interventions; results of practice patterns and risk analyses of the earlier (1987-90) AMI cohorts, however, were published concurrently with the actual practices of the more recent (1991-92) cohorts and may have had some indirect effect on the recent practice patterns. Results Univariate analysis showed that mortality was higher (p Conclusions Among contemporary AMI patients, advanced age and female sex are associated with relative under-utilization of proven effective medical therapy and increased risk of dying in the hospital. Although the contribution of age to AMI risk appears greater than that of gender, survival in any high risk group would likely be improved by increased use of proven medical therapy. ( Chest 1994; 105:1687-92 )