Table 2. Trends in 90-Day Post-Discharge Total Mortality in Patients Aged 85 Years or More Hospitalized with Acute Myocardial Infarction Between 1997 and 2007.
| Model 1 | Model 2 | Model 3 | Model 4 | |
|---|---|---|---|---|
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| Characteristic | Unadjusted HR (95% CI) | Model 1 + Adjusted for Patient Characteristics (* Comorbidity and 90-d AMI Mortality Risk) Adjusted HR (95% CI) | Model 2 + Adjusted for Guideline-based Medication Use Adjusted HR (95% CI) | Model 3 + Adjusted for Interventional Procedures Adjusted HR (95% CI) |
| Study Year (2003-2007 vs 1997-2001 [ref]) | 0.73 (0.60-0.89) | 0.78 (0.64-0.96) | 1.26 (1.00-1.58) | 1.28 (1.02-1.62) |
| Prescribed in hospital and at discharge | ||||
| Aspirin | - | - | reference | reference |
| ACEI/ARB | - | - | reference | reference |
| Lipid-lowering agent | - | - | reference | reference |
| Beta-blocker | - | - | reference | reference |
| Prescribed in hospital only | ||||
| Aspirin | - | - | 2.61 (1.99-3.44) | 2.66 (2.03-3.50) |
| ACEI/ARB | - | - | 2.09 (1.50-2.90) | 2.24 (1.61-3.12) |
| Lipid-lowering agent | - | - | 1.65 (1.08-2.53) | 1.50 (0.98-2.30) |
| Beta-blocker | - | - | 2.44 (1.83-3.27) | 2.43 (1.82-3.25) |
| Never prescribed | ||||
| Aspirin | 2.03 (1.44-2.50) | 1.94 (1.43-2.65) | ||
| ACEI/ARB | 1.90 (1.38-2.32) | 1.87 (1.42-2.46) | ||
| Lipid-lowering agent | 1.60 (1.17-2.19) | 1.46 (1.07-2.00) | ||
| Beta-blocker | 2.16 (1.62-2.88) | 2.12 (1.60-2.83) | ||
| Interventional procedures | ||||
| PCI or CABG (vs none) | - | - | - | 0.40 (0.24-0.67) |
ACEI = angiotensin-converting enzyme inhibitor; AMI = acute myocardial infarction; ARB = angiotensin receptor blocker; CABG = coronary artery bypass grafting; CI = confidence interval; HR = hazard ratio; PCI = percutaneous coronary intervention.
Comorbidity (history of heart failure, angina) and the predicted probability of 90-day acute myocardial infarction mortality risk based on an adaptation of the model by Krumholzet al20 (including age, sex, diabetes, stroke, history of myocardial infarction, hypertension, chronic obstructive pulmonary disease, history of coronary artery bypass grafting or angioplasty, hypotension in the first 48 hours, in-hospital shock, in-hospital heart failure, initial blood urea nitrogen, initial serum creatinine, initial white blood cell count, and initial electrocardiogram findings [left bundle branch block, right bundle branch block, and ST elevation]).