Trends in treatment and outcomes for acute myocardial infarction: 1975-1995

Am J Med. 2001 Feb 15;110(3):165-74. doi: 10.1016/s0002-9343(00)00712-9.


Purpose: To review the trends in treatment and survival for patients with acute myocardial infarction over the last 20 years.

Material and methods: Studies were identified through MEDLINE searches and review of study bibliographies. Additional data were obtained from the Health Care Financing Administration including data from Medicare claims files (part A). Thirty-day mortality rates were calculated using Medicare data and case fatality rates from the National Hospital Discharge Survey. Published meta-analyses were used to determine treatment effects. Published studies were included if they reported the use of therapies for acute myocardial infarction at a population level. Trends in the demographic characteristics of the patients as well as infarct characteristics, medication use, and revascularization were recorded.

Results: The use of acute treatments that are known to improve survival among patients with myocardial infarction has increased markedly during the last 20 years, leading to an estimated 9.6% reduction (from 27.0% to 17.4%) in 30-day mortality. After adjusting for potential interactions between therapies, the increase in use of aspirin, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, and reperfusion can explain 71% of the decrease in the 30-day age- and sex-adjusted mortality rate from 1975 to 1995. The greatest effect of a given therapy was that of aspirin, which accounted for 34% of the decrease in 30-day mortality, followed by thrombolysis (17%), primary angioplasty (10%), beta-blockers (7%), and ACE inhibitors (3%). If other treatments (such as heparin or nonprimary angioplasty), whose effects on mortality are less certain, are included, up to 90% of the decrease in 30-day mortality can be explained by changes in treatment.

Conclusions: The primary reason for the decrease in early mortality from myocardial infarction during the last 20 years appears to be increased use of effective treatments.

Publication types

  • Meta-Analysis
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Angioplasty, Balloon, Coronary
  • Cardiovascular Agents / therapeutic use
  • Coronary Artery Bypass
  • Humans
  • Incidence
  • Medicare
  • Mortality / trends
  • Myocardial Infarction / drug therapy
  • Myocardial Infarction / mortality*
  • Myocardial Infarction / surgery
  • Myocardial Infarction / therapy*
  • Randomized Controlled Trials as Topic
  • Thrombolytic Therapy
  • Treatment Outcome
  • United States / epidemiology


  • Cardiovascular Agents