Survival in acute myocardial infarction

Abstract

In their Article (April 2, p 1305),1Chung S-C Godeborg R Nicholas O et al.Acute myocardial infarction: a comparison of short-term survival in national outcome registries in Sweden and the UK.Lancet. 2014; 383: 1305-1312Summary Full Text Full Text PDF PubMed Scopus (200) Google Scholar Sheng-Chia Chung and colleagues establish a comparison between Sweden and the UK in which only 2·3% (95% CI 2·2–2·3) of patients in the UK and 1·3% (1·3–1·4) of patients in Sweden had been recorded as being admitted to hospital after out-of-hospital cardiac arrest. In our Viewpoint,2Julian DG Norris RM Myocardial Infarction: is evidence-based medicine the best? Viewpoint.Lancet. 2002; 359: 1515-1516Summary Full Text Full Text PDF PubMed Scopus (18) Google Scholar we pointed out that resuscitation from cardiac arrest had prevented 4 times as many deaths than the then prevalent method for reperfusion (streptokinase) and that in the studies on which these estimates were based,3The United Kingdom Heart Attack Study Collaborative GroupEffect of time from onset to coming under care on fatality of patients with acute myocardial infarction: effect of resuscitation and thrombolytic treatment.Heart. 1998; 80: 114-120Crossref PubMed Scopus (52) Google Scholar, 4Norris RM for the Southern Heart Attack Response Project (SHARP) investigatorsA new performance indicator for acute myocardial infarction.Heart. 2001; 85: 395-401Crossref PubMed Scopus (13) Google Scholar the percentage of patients who had survived out-of-hospital arrest was 5·0% for The United Kingdom Heart Attack Study Collaborative Group and 4·4% for the Southern Heart Attack Response Project. These patients have a high hospital fatality rate (odds ratio for deaths is 4·55 in Sweden and 4·78 in the UK, as stated in their supplementary appendix).1Chung S-C Godeborg R Nicholas O et al.Acute myocardial infarction: a comparison of short-term survival in national outcome registries in Sweden and the UK.Lancet. 2014; 383: 1305-1312Summary Full Text Full Text PDF PubMed Scopus (200) Google Scholar It is difficult to escape the conclusion that patients surviving out-of-hospital cardiac arrest were under-reported in the registries of both countries and that fuller reporting would have increased the fatality rates, more so in Sweden than in the UK. Survival from out-of-hospital cardiac arrest varies widely among ambulance districts5Perkins GD Cooke MW Variability in cardiac arrest survival: the NHS Ambulance Service Quality Indicators.Emerg Med J. 2012; 29: 3-5Crossref PubMed Scopus (83) Google Scholar and in one district was improved markedly after rigorous retraining of paramedics.6Fletcher D Chamberlain D Handley A et al.Utstein-style audit of Protocol C: a non-standard resuscitation protocol for healthcare professionals.Resuscitation. 2011; 82: 1265-1272Summary Full Text Full Text PDF PubMed Scopus (14) Google Scholar Resuscitation from cardiac arrest is still a very important but neglected specialty in audits of treatment for the acute coronary syndromes. I declare no competing interests. Acute myocardial infarction: a comparison of short-term survival in national outcome registries in Sweden and the UKWe found clinically important differences between countries in acute myocardial infarction care and outcomes. International comparisons research might help to improve health systems and prevent deaths. Full-Text PDF Open AccessMyocardial infarction: is evidence-based medicine the best?Myocardial infarction carries a high mortality and is the commonest single cause of death in developed countries. Effective treatment is obviously of paramount importance to patients, physicians, and health authorities. Infarction usually occurs when a fissure develops in an atheromatous plaque upon which platelet and fibrin thrombi form, leading to occlusion of a coronary artery and, often, death. Fibrinolytic drugs, such as streptokinase and alteplase, have been subjected to very large, excellently conducted randomised clinical trials that have shown beyond reasonable doubt that this form of therapy, if applied early in the course of the disorder, is highly effective and relatively safe. Full-Text PDF Survival in acute myocardial infarction – Authors' replyWe thank Robin Norris for his comments on our study,1 and we strongly agree with him that resuscitation after out-of-hospital cardiac arrest is an important aspect of the quality of care of patients with acute coronary syndromes. We propose linkage of electronic health records across primary care, the ambulance service, and national quality registries for cardiac arrest and cardiac diseases to better understand, and improve management and outcome. Norris is correct in stating that the national acute coronary syndrome (ACS) registry data that we report only includes patients admitted to hospital, and therefore excludes patients who died before reaching hospital. Full-Text PDF