Which factors determine the long-term outcome among patients with a very small or unconfirmed AMI

Abstract

Aim: To describe various factors associated with the very long-term prognosis for patients with a very small or an unconfirmed acute myocardial infarction (AMI). Methods: Patients below 76 years of age, hospitalized due to suspected AMI who either developed a very small AMI (enzyme elevation<twice upper normal limit and maximum serum (S) aspartate aminotransferase (S-ASAT)<1.4 ukat/l) or an unconfirmed AMI (a suspected ischemic event with no signs of myocardial necrosis) were evaluated at our out-patient clinic. The 10-year mortality was related to the clinical history, age and sex, metabolic factors, diagnosis at hospital discharge, various psychosocial factors, use of medication, current symptoms, underlying reason to the symptoms, maximal working capacity and other observations at bicycle exercise test including signs of myocardial ischemia. Results: In all, 714 patients (33% women) with a median age of 63 years were included in the analyses. The following appeared as independent risk indicators for 10-year mortality: S-gammaglutamyl transpeptidase (GT) ( P<0.0001), age ( P<0.0001), current smoking ( P<0.0001), a history of previous AMI ( P<0.0001), maximal working capacity at bicycle exercise test ( P=0.002), and current treatment with digitalis (borderline significance; P=0.022). Conclusion: Among patients with a suspected acute myocardial ischemic event with no or minimal myocardial necrosis, various factors reflecting their age, history of cardiac disease and smoking, liver function, working capacity and possibly use of medication affected their very long-term prognosis.