Predictors of death and mode of death during long-term follow-up among patients with unconfirmed acute myocardial infarction.

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Among patients hospitalized with a suspected acute coronary syndrome, a minority will eventually develop a confirmed acute myocardial infarction (AMI). In the remaining patients, coronary artery disease is the underlying cause in a large proportion. The aim of the study was to determine risk indicators for death and the mode of death during 5 years of follow-up among patients hospitalized and surviving hospitalization, who presented with initially suspected AMI, but in whom infarction was not confirmed. Consecutive patients who fulfilled the above criteria and were discharged from Sahlgrenska Hospital alive during 1986 and 1987 were followed for 5 years. In all, 1,227 patients, of whom 396 (34%) died during the 5 years of follow-up, fulfilled the criteria. The following factors appeared to be independent risk indicators for death: age (p < 0.001); male gender (p < 0.001); a history of either current smoking (p < 0.001), congestive heart failure (p < 0.01), or myocardial infarction (p < 0.05); congestive heart failure during hospital stay (p < 0.01); and prescription of digitalis at discharge (p < 0.05). Among patients who died, only 63% were judged to have been dying a cardiac death. Among patients hospitalized with suspected acute coronary syndrome and discharged from hospital without a confirmed AMI, one third had died during the 5 years of follow-up. Risk indicators for death were related to age, male gender, history of current smoking, congestive heart failure or previous AMI, congestive heart failure in hospital, and digitalis medication at discharge.