Long-term survival and predictors of mortality in Coronat)' Heart Disease

Coronruy heart disease (CHD) is by far the most important cause of death, and a main cause of disability in the Netherlands. Accordingly, coronruy heart disease has a great impact on society. In 1995 cardiac death occurred in about 40,000 persons (28% of all monality) and ischemic heart disease was the reason for 170,000 hospital admissions. I Since the 1980s an inunediate benefit is achieved in patients with acute manifestations of CHD, with pharmacologic therapy such as thrombolytic therapy in patients with evolving myocru·dial infarction and coronary interventions such as coronary aorto bypass graft surgery (CABG) and percutaneous transluminal coronary angioplasty procedure (PTCA). Together with improved secondalY prevention through diet, reduced smoking and medical regimens such as antiplatelets, beta-blockers, ace-inhibitors and statins the life expectancy has been improved. This resulted in an increase of patients with chronic manifestations of CHD including heart failure and a population of survivors with a high risk of recurrent coronary events. This make the investigation of the long-telm outcome after a cardiac event more imponant than ever. We investigated subgroups of patients who undelwent myocardial infarction (Ml), an episode of unstable angina pectoris (UAP), CABG or PTCA. This chapter will give an overview of previous studies which reponed the long-term outcome of the different groups of patients including: survivors of a myocardial infarction (1.1.1), patients with evolving myocardial infarction who were treated with thrombolytic therapy or conventional therapy (1.1.2), patients hospitalized for unstable angina (1.2), patients who undelwent CABG surgery (1.3) and patients who undelwent a PTCA procedure either without (1.4.1) or with stent implantation (1.4.2). The most imponant baseline characteristics of each of these subgroups and their effects on medium- and long-term outcome are presented.

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