Coronary angioplasty during hospitalization for acute myocardial infarction is associated with higher 5-year survival

Objective: To assess whether coronary angioplasty (PTCA) during hospitalization for acute myocardial infarction improves short- and long- term mortality. Background: Coronary reperfusion has been proven to lower mortality in patients with acute myocardial infarction. Although major trials of reperfusion therapy have demonstrated improved outcome, because of the restrictions of the inclusion criteria, they do not necessarily reflect clinical practice. Methods: Analysis of state-wide hospital discharge database containing records of 42,595 patients admitted in the years 1986- 87. Record linkage was performed to allow follow-up for survival. Results: Patients undergoing PTCA were younger (58 ± 11 years) than patients without this procedure (65 ± 12 years, p < 0.0001). In the PTCA group, there were more Caucasian patients and less comorbidity. Early revascularization (PTCA within 48 hours from admission) was performed in 41% of the patients. The crude 5-year survival rate was significantly higher among patients who had PTCA compared to patients who did not undergo PTCA during the index hospitalization (88% vs. 61%, p < 0.0001). Adjusted death-rate ratios (R.R.) were significantly lower for patients aged 50 and above who received PTCA (R.R. = 0.526, 50-69 years, R.R. = 0.455, 70-89 years). The reduction in death-rate ratio is observed for PTCA performed either early or late in hospitalization. Conclusion: This analysis of a state-wide database indicates that PTCA, at any time during the hospitalization for acute myocardial infarction, is associated with improved short- and long-term survival. Although selection bias is possible, the survival benefit still persists after controlling for differences in age, gender and comorbidity.