"Apatient hospitalized with acute myocardial infarction
(AMI) in the year 2000 has a markedly improved
chance of survival than would have been
possible 10 or even 5 years ago. A study by Louise Pilote
and colleagues1 in this issue (page 31) is important because
it documents this improvement on a population basis.
Whereas most clinical studies of treatment outcomes of
AMI have been based on selected patient samples,2–6 the
Pilote retrospective study reviewed the cases of all patients
in a Quebec government database who had an AMI between
1988 and 1995. All-cause 1-year mortality dropped
from 23% in 1988 to 19% in 1994; inhospital mortality declined
from 14% to 11% and 30-day mortality from 15%
to 12%. This decline in mortality parallels other published
reports on AMI patients involved in large multicentre clinical
trials.2–6 Knowing that this improvement has occurred
and is likely true, it is important to try to understand what
specific changes in management are responsible."
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