Improvement in Survival After Myocardial Infarction Between 1978-85 and 1986-88 in The REGICOR Study - REGICOR

Description:

The REGICOR study was a registry of patients age 25 to 74 years admitted to a coronary care unit (CCU) in Girona, Spain with first transmural myocardial infarction (MI). The aim of the present study was to assess differences in 28-day case-fatality and three-year mortality in patients from two time periods: 1978-85 and 1986-88. Multiple other papers have been published using the REGICOR dataset including analyses of cardiac risk factors and genetic associations.

Study Design

Study Design:

Patients Enrolled: 1,216
Mean Follow Up: Three years
Mean Patient Age: 25-75
Female: 44

Patient Populations:

Patients with first acute MI admitted to a CCU in Girona, Spain. Acute MI was defined as presence of definite new Q or QS waves on ECG with at least one of the following: 1) increased MI enzymes twofold or greater above the upper limit of normal, or 2) typical pain in the anterior chest lasting 20 or more minutes for which no cause other than ischemic heart disease could be found. Also age <75 years, chest pain no longer than 2.75 hours, and duration before the first examination.

Exclusions:

Nontransmural MIs

Primary Endpoints:

Twenty eight-day and three-year mortality (for patients surviving the first 28 days)

Secondary Endpoints:

Killip class during hospitalization, use of angiography, angioplasty, and CABG

Drug/Procedures Used:

REGICOR was an observational registry. Patients were continually enrolled from 1978 through 1986. Patients were divided into two groups: Group 1, enrolled from 1978 through 1985, and Group 2, enrolled from 1986-1988.

Principal Findings:

A total of 1,216 patients were enrolled in the registry for the time periods of interest, 842 patients from 1978-85 (Group 1) and 374 patients from 1986-88 (Group 2). In terms of baseline characteristics, there were no significant differences between groups for age (mean 59.7 for both groups), gender, or smoking status. Significant differences did occur between groups 1 and 2 for hypertension (51.8% vs. 65.2%), diabetes (19% vs. 21.9%, p<0.001), history of prior angina (29.3% vs. 22.8%), and presence of Killip class III or IV during hospitalization (13.7% vs. 6.1%, p<0.001).

During the 28 days after symptom onset, Group 2 had a higher incidence of coronary angiography (0.6% vs. 4%, p<0.001) and revascularization (0.4% vs. 2.4%, p<0.004) via either angioplasty or coronary artery bypass grafting (CABG). Mortality at 28 days was significantly improved in the later time period (group 2) from 14.6% to 8.8%, p=0.007. After adjusting for gender, age, hypertension, and diabetes in a logistic regression model, the risk of death was 35% lower in 1986-88 than 1978-85 (relative risk 0.65, 95% confidence interval 0.42-0.99). When the model went further to adjust for Killip class, the time period effect completely disappeared.

Mortality at three years (for patients surviving the first 28 days) was similar between groups (8.2% vs. 8.3%, p=NS). In a logistic regression model, three-year mortality was not affected by time period even when adjusted for age, gender, diabetes, hypertension, and Killip class.

Interpretation:

Admission to a CCU with first acute MI from 1986-88 was associated with lower 28-day mortality but similar three-year mortality compared with the time period 1978-85. Using logistic regression, the improvement in 28-day mortality was largely explained by differences in Killip class between the two time periods. Between these two time periods, use of angiography and revascularization increased significantly.

References:

Sala J, Marrugat J, Masia R, Porta M. Improvement in survival after myocardial infarction between 1978-85 and 1986-88 in The REGICOR Study. (Registre GIroni del COR) registry. Eur Heart J 1995;16:779-84.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Aortic Surgery, Interventions and Imaging, Angiography, Nuclear Imaging, Hypertension, Smoking

Keywords: Myocardial Infarction, Coronary Angiography, Chest Pain, Risk Factors, Confidence Intervals, Electrocardiography, Coronary Artery Bypass, Angioplasty, Hypertension, Diabetes Mellitus, Logistic Models, Smoking


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