Manifestations and Survival in Coronary Heart Disease

Aim: To investigate how risk factors predict manifestations in coronary heart disease (CHD), and trends in short-term and long-term survival including trends in out-of-hospital mortality. Populations and methods: In the first study 7388 men aged 47 to 55 and free of previous acute myocardial infarction (AMI) or stroke were investigated during 28 years’ follow-up. In the second and third study we created a record linked database from the Swedish hospital discharge and death registries documenting all cases aged 35 to 84 years who had either been hospitalized for a first AMI or who had died from CHD outside hospital without a prior hospitalization for AMI. In the last study data were derived from 143, 457 consecutive patients aged 25 to 105 years from the Swedish Register of Cardiac Intensive Care (RIKS-HIA) with a first episode of either AMI or unstable angina (UAP). Results: Serum cholesterol was a stronger predictor (OR 5.21) for future coronary artery bypass grafting (CABG) than for AMI. Smoking was a weaker risk factor for CABG than for AMI with no discernible increase in risk except in very heavy smokers (OR 2.19). Both short- and long-term case fatality after hospitalization for AMI decreased from 1987 to 1998, more in younger than in older patients. 28-day case fatality was reduced by half in male and female patients