Makhlouf, M., Mahdy, N. (2004). Survival Model for Patient with Acute Myocardial Infection. Journal of High Institute of Public Health, 34(3), 469-508. doi: 10.21608/jhiph.2004.185916
Mohamed M M. Makhlouf; Nehal H. Mahdy. "Survival Model for Patient with Acute Myocardial Infection". Journal of High Institute of Public Health, 34, 3, 2004, 469-508. doi: 10.21608/jhiph.2004.185916
Makhlouf, M., Mahdy, N. (2004). 'Survival Model for Patient with Acute Myocardial Infection', Journal of High Institute of Public Health, 34(3), pp. 469-508. doi: 10.21608/jhiph.2004.185916
Makhlouf, M., Mahdy, N. Survival Model for Patient with Acute Myocardial Infection. Journal of High Institute of Public Health, 2004; 34(3): 469-508. doi: 10.21608/jhiph.2004.185916
Survival Model for Patient with Acute Myocardial Infection
1Department of Family Health, High Institute of Public Health, Alexandria University, Egypt
2Department of Biostatistics, High Institute of Public Health, Alexandria University, Egypt
Abstract
Acute myocardial infection [AMI] is one of the most dramatic illnesses that can afflict our patients. Almost two-third of heart attack patients do not make a complete recovery, and people who survive the acute phase have a chance of related illness and death that is 2 to 9 times higher than that of the general population. The present work aimed at determining factors that may affect in-hospital mortality of patients with myocardial infarction, at calculating the 30-days survival rates, and at constructing different models of survival rates according to different factors. A 30 days follow up study was carried out on 340 patients with acute myocardial infarction who were admitted to the Main Alexandria University Hospital and Gamal Abd El-Naser Hospital. The present study revealed a case fatality rate of 11.8% at hospital, while 78% survival up to 30 days. Stepwise discriminant analysis yielded that, occurrence of complications and lack of prescription of B-blockers were the two main predictors for in-hospital deaths. Kaplan-Meier survival curves displayed that significant lower probability of 30-days survival was detected among the elderly, those with high blood sugar, with high or low systolic or diastolic blood pressure on admission, those who had complications at hospital, and those with no prescription of beta-blockers [B-blockers], Angiotensin Converting Enzyme inhibitors [ACE-I], aspirin, and streptokinase medications. A multivariate stepwise Cox regression revealed three predictors of 30-days survival, the first one was age of the patients, those aged 60- <75 or 75 years or more demonstrated a higher risk of deaths compared to those aged <45 years, the second and third predictors were lack of prescription of B-blockers and ACE-I medication, those who didn’t receive these medications had the risk of about two times of deaths compared to those who received such medication. Primary prevention of coronary artery disease and AMI should be emphasized. It is important to effectively implement preventive actions in all high risk individual and to expand delivery of acute treatment in a timely fashion for all eligible patients. It is essential that the primary care physician be fully informed and actively involved in the implementation of treatment strategies designed for secondary prevention of myocardial infarction.
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