Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Clinical Investigation
Modification of Treatment Strategies Over a Period of 14 Years Has Markedly Reduced Cardiac Events Among Post-Myocardial Infarction Patients
Kinji IshikawaAkio KimuraTakaaki TaniwaToshihiko TakenakaTakahiro HayashiKen Kanamasaon behalf of the Secondary Prevention Group
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2002 Volume 66 Issue 10 Pages 881-885


Recent trends in the treatment of post-myocardial infarction (MI) patients and the factors accounting for the improvement in outcome are presented. A total of 6,602 post-MI patients (5,320 males, 1,282 females; 58.9±10.4 years of age) enrolled between 1986 and 1999 were followed up for an average of 12.6±16.3 months. The incidence of cardiac events, which included fatal and nonfatal recurrent MIs, sudden death and death by congestive heart failure, was highest (44.9 events/1,000 person · year) in 1986-1987, but decreased steadily to 22.5 events/1,000 person · year by 1997-1999 (Trend p<0.0001). This trend accompanied the increased use of coronary thrombolysis, percutaneous transluminal coronary angioplasty and coronary artery bypass graft surgery, increased prescription of antiplatelet agents (51.5%→83.4%), lipid-lowering agents (29.8%→52.6%) and angiotensin-converting enzyme inhibitors (5.3%→41.0%), and reduced prescription of calcium antagonists (68.5%→41.0%) and nitrates (60.7%→45.7%). These changes in treatment have led to a decreased incidence of angina pectoris, wall motion abnormalities and abnormal Q waves on electrocardiograms. The decline in the incidence of cardiac events among post-MI patients in the 14 years between 1986 and 1999 reflects implementation of new therapeutic modalities proven to be effective in clinical trials and in daily practice. (Circ J 2002; 66: 881 - 885)

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