PMID- 22075191
OWN - NLM
STAT- MEDLINE
DCOM- 20120419
LR  - 20111125
IS  - 1768-3181 (Electronic)
IS  - 0003-3928 (Linking)
VI  - 60
IP  - 6
DP  - 2011 Dec
TI  - [Mortality of myocardial infarction].
PG  - 311-6
LID - 10.1016/j.ancard.2011.10.001 [doi]
AB  - Coronary disease is a major cause of death and disability. From 1975 to 2000, 
      coronary mortality was reduced by half. Better treatments and reduction of risk 
      factors are the main causes. This phenomenon is observed in most developed 
      countries, but mortality from coronary heart disease continues to increase in 
      developing countries. In-hospital mortality of ST elevation myocardial infarction 
      (STEMI) is in the range of 7 to 10% in registries. In infarction without ST 
      segment elevation (NSTEMI), in-hospital mortality is around 5%. More recent 
      studies found a similar in-hospital mortality for STEMI and NSTEMI. Because of 
      patient selection and monitoring, mortality in clinical trials is much lower. 
      After adjustment for the extent of coronary disease, age, risk factors, history 
      of myocardial infarction, the excess mortality observed in women is fading. Many 
      clinical, biological and laboratory parameters are associated with mortality in 
      myocardial infarction. They refer to the immediate risk of death (ventricular 
      rhythm disturbances, shock...), the extent of infarction (number of leads with ST 
      elevation on the ECG, release of biomarkers, ejection fraction...), the presence of 
      heart failure, the failure of reperfusion and the patient's baseline risk (age, 
      renal function...). Risk scores, and more specifically the GRACE risk score, 
      synthesize these different markers to predict the risk of death in a given 
      patient. However, their use for the treatment of myocardial only concerns NSTEMI. 
      Only a limited number of mechanical or pharmacological interventions reduces 
      mortality of heart attack. The main benefits are observed with reperfusion by 
      thrombolysis or primary angioplasty in STEMI, aspirin, heparin, beta-blockers, 
      angiotensin converting enzyme inhibitors. Some medications such as bivalirudin 
      and fondaparinux reduce mortality by decreasing the incidence of hemorrhagic 
      complications. The guidelines classify interventions according to their benefit 
      and especially their ability to reduce mortality. Organized care systems that 
      improve implementation of guidelines also reduce mortality. Finally, some new 
      therapeutic approaches such as post-conditioning and new therapeutic classes 
      offer encouraging prospects for further reducing the mortality of myocardial 
      infarction.
CI  - Copyright (c) 2011. Published by Elsevier SAS.
FAU - Bonnefoy, E
AU  - Bonnefoy E
AD  - Soins intensifs et urgences cardiologiques, hopital cardiovasculaire et 
      pneumologique Louis-Pradel, BP Lyon-Montchat, France. 
      eric.bonnefoy-cudraz@chu-lyon.fr
FAU - Kirkorian, G
AU  - Kirkorian G
LA  - fre
PT  - English Abstract
PT  - Journal Article
TT  - La mortalite des syndromes coronariens aigus.
DEP - 20111025
PL  - France
TA  - Ann Cardiol Angeiol (Paris)
JT  - Annales de cardiologie et d'angeiologie
JID - 0142167
SB  - IM
MH  - Developed Countries/statistics & numerical data
MH  - Developing Countries/statistics & numerical data
MH  - Evidence-Based Medicine
MH  - Female
MH  - France/epidemiology
MH  - Heart Conduction System/physiopathology
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Monitoring, Physiologic
MH  - Mortality/trends
MH  - Myocardial Infarction/*epidemiology/mortality/physiopathology/surgery/*therapy
MH  - *Myocardial Reperfusion/methods
MH  - Patient Selection
MH  - Practice Guidelines as Topic
MH  - Risk Factors
MH  - Survival Rate
MH  - Treatment Outcome
EDAT- 2011/11/15 06:00
MHDA- 2012/04/20 06:00
CRDT- 2011/11/15 06:00
PHST- 2011/11/15 06:00 [entrez]
PHST- 2011/11/15 06:00 [pubmed]
PHST- 2012/04/20 06:00 [medline]
AID - S0003-3928(11)00191-0 [pii]
AID - 10.1016/j.ancard.2011.10.001 [doi]
PST - ppublish
SO  - Ann Cardiol Angeiol (Paris). 2011 Dec;60(6):311-6. doi: 
      10.1016/j.ancard.2011.10.001. Epub 2011 Oct 25.