Preinfarction Blood Pressure and Smoking Are Determinants for a Fatal Outcome of Myocardial Infarction

Abstract

GREAT EFFORTS have been made to reduce in-hospital fatality rate due to myocardial infarction (MI), but more than 50% of coronary deaths occur suddenly and outside of hospitals.^1-7 Therefore, one should identify those factors that influence the risk of dying of a heart attack and, if possible, intervene on such factors before the event occurs. Smoking, serum cholesterol levels, and blood pressure are the classic coronary risk factors, but so far no firm conclusion has been drawn as to their role for a fatal outcome in MI.^1,8-12 Factors that are known to influence the case fatality rate are an advanced age,^1,3,12-15 a previous infarct,^1,10,12,14 and diabetes mellitus.^10,16-18 Some studies claim that women fare better^11,14,17,18 or worse^19,20 than men after a major heart attack, while others^21-25 found no independent effect of sex. The size and location of an infarct are important immediate predictors for subsequent death.^9,26