Angioplasty but not thrombolysis improves short-term mortality of acute myocardial infarction. A multicenter survey in Yamagata, Japan.

Abstract

There are few district-based surveys to investigate the actual effects of thrombolytic therapy and percutaneous transluminal coronary angioplasty (PTCA) on short-term mortality in patients with acute myocardial infarction (AMI) in Japan. The study population comprised 974 patients (319 women and 655 men, aged 69 +/- 12 years) admitted with confirmed AMI to 41 hospitals in Yamagata Prefecture from January 1, 1994 to December 31, 1996. Thrombolysis and PTCA were performed in 262 (27%) and 428 (44%) patients, respectively, and 161 patients died within 28 days after the onset of AMI (short-term mortality 16.5%). Thirteen variables, including risk factors and clinical manifestations, were examined by bivariate and multiple logistic regression analyses to identify the predictors of short-term mortality. Multiple logistic regression analysis, incorporating variables with a p value < 0.05 in a bivariate analysis, demonstrated that advanced age, history of myocardial infarction and Killip class III or IV independently correlated with increased short-term mortality and treatment with PTCA independently correlated with decreased short-term mortality (odds ratio 0.21, 95% confidence interval [CI] 0.11-0.39). Thrombolytic therapy was not an independent predictor of short-term mortality (odds ratio 0.67, 95% CI 0.37-1.20). Treatment with PTCA but not thrombolysis significantly improved the short-term mortality in patients with AMI in our area-based study.