In-hospital and follow-up mortality of patients with acute myocardial infarction.

Patients with definite acute MI who were admitted to Songkla University Hospital between 1982 and 1990 were studied. The 195 patients and 202 admissions were nearly equally distributed between these 65 and older versus those younger than 65. Three quarters were males. The in-hospital mortality was 19.5 per cent and 76.3 per cent of the deaths were from heart failure. Neither age nor gender determined the mortality once corrected for the Killip's staging. There was no difference in mortality when comparing Q versus non-Q MI, anterior versus inferior wall MI or males versus females. One hundred and thirty-eight patients could be followed for and average of 27.1 months. First year mortality was 11 per cent and the first 2 years was 14 per cent. The in-hospital mortality, representing the prethrombolytic era, appeared to be similar to values reported from the Thai and Western literature. The predominance of death from heart failure rather than from arrhythmia may be a consequence of delayed admission whence arrhythmic death had already occurred or patients will seek hospital advice only if highly symptomatic.

Double-blind evaluation of enalapril in patients with systolic heart failure.

Fifty-six patients with a mean age of 58 years, 14 females and 42 males, all with dominant systolic heart failure (33 in functional class 3 and 4) were randomised to receive either added placebo or added enalapril to their heart failure medication. There were 13 patients in this group who had their trial drug switched after a certain period to allow direct but blind comparison between placebo and enalapril. Cardiac mortality with enalapril was 32 per cent compared to 48 per cent with placebo at intervals after initiating therapy of 20.0 +/- 19.4 versus 14.3 +/- 11.5 months respectively. When compared to a preceding control period, 80 per cent of the enalapril patients improved in contrast to 21 per cent of the placebo. However, when a comparison was made directly between enalapril and placebo, enalapril was better in 31 per cent and placebo was better in 8 per cent of the patients. It is concluded that in certain patients with systolic heart failure from non-valvular and non-hypertensive causes, enalapril is beneficial when added to the conventional treatment. An argument is also presented that to cost-effectively identify the group who will benefit, a short term ACE-I trial after the conventional antifailure therapy can be considered in all patients with systolic heart failure.

Embolism and atrial fibrillation. A longitudinal follow-up.

Six hundred and forty-nine patients with proven chronic atrial fibrillation were followed for a total of 1,436 patient-years without anticoagulation. The patient were divided into 7 disease groups with each having an average age ranging from 39 to 69 years. Eleven per cent of the patients had systemic embolism prior to being registered for the follow-up. The diseases which had the highest incidence of embolism prior to being followed were the same as those producing the highest rate of systemic embolism while under observation. The disease groups were rheumatic valvular (predominantly mitral stenosis) and ischemic heart diseases. Their embolic rate were 3.9 to 5.1 emboli per 100 pt-yr. Other disease groups with lower embolic rates of 0 to 0.9 per 100 pt-yr were heart failure, non-rheumatic mitral regurgitation, atrial septal defect and thyrotoxicosis. Since the incidence of systemic embolism varied according to the primary disease, and since the hemorrhagic complication of anticoagulant therapy is finite, it is advised that low risk group may not benefit greatly from anticoagulation. However, the true low risk group has still to be properly determined.

Patients with prosthetic cardiac valves followed in southern Thailand.

Prospective follow-up of 174 post-prosthetic cardiac valves have been done at Prince of Songkla University and Hat Yai Regional hospitals since 1985. The total follow-up time was 549 patient-years (pt-yr). Thirty per cent had been followed for 1 year or less. Eighty-two per cent of the patients had their mitral valves replaced either singly or as part of a multiple replacement. Thirty per cent of the time, the prothrombin time was below therapeutic range. Major events did not appear to be different from other reports: 2.7 embolic events per 100 pt-yr, 3.2 major bleeds and 3.2 deaths which may eventually be as high as 4.4 if a portion of the lost patients was assumed to have died. Events related to prosthetic valves and anticoagulation seemed to occur predominantly 1-2 years after surgery.