Abstract
Background and Objects: In Iran, like many other countries, coronary artery disease is the most common cause of death. In recent decades there has been a significant decrease in the prevalence and fatality rate of acute myocardial infarction (AMI) attributable to both, a decreased prevalence of major risk factors and development of new therapies. The aim of this study is to evaluate such evolutions and their effect on mortality and morbidity of AMI during the past 20 years.
Methods & Materials: Records of 600 AMI patients hospitalized in Shahid Madani Hospital, Tabriz during the past two decades (1986 to 2005) were evaluated in an analytic-descriptive study. Patients’ general characteristics, risk factors, complications, treatments, and in-hospital mortality rate were assessed. The patients were categorized in three groups: years 1986-1992 (majority with medical therapy without reperfusion), years 1993-1998 (beginning of thrombolytic therapy in our center), 1999-2005 (beginning of angioplasty in our center), 200 patients in each one. The mentioned parameters were compared between the 3 groups.
Results: Six hundred patients, 440 (73.3%) males and 160 (26.7%) females with the mean age of 60.03±11.61 years enrolled in the study. The mean age (p<0.001), frequency of hyperlipidemia (p=0.001), ventricular fibrillation and/or tachycardia beyond second day of AMI (p=0.024), prescription of beta-blockers (p<0.001), ACEIs (p<0.001), streptokinase (p<0.001) and PTCA (p<0.001) showed significant increase during this period. On the other hand, the mean duration of hospitalization (p<0.001) and frequency of smoking (p<0.001) decreased significantly during the past two decades. There was no significant changes regarding the mortality (p=0.533) and heart failure (p=0.403) rates.
Conclusion: Our results showed a significant improvement in management of patients with AMI. According to international guidelines in our center; however, inadequate use of coronary reperfusion strategies has led to a relatively fixed rate of mortality and major complications in the past two decades.