Aziz, Aniza Abd.
(2006)
Survival and prognostic factors of hospitalized acute myocardial infarction patients in district of Kota Bharu, Kelantan : a retrospective cohort study 2000-2003.
Masters thesis, Universiti Sains Malaysia.
Abstract
INTRODUCTION
Acute n1yocardial infarction (AMI) ren1ains a major public health problen1 in Malaysia
despite advances in medical management and technology. Local prognostic data on AMI
will provide an essential information for effective preventive measures. The objectives of
the study were to determine the survival of hospitalized acute n1yocardial infarction
patients in Kota Bharu and identify the prognostic factors that influence the risk of death.
METHODOLOGY
A retrospective cohort study was conducted involving 368 hospitalized AMI patients
from the district of Kota Bharu who were adtnitted in two tet1iary hospital; Hospital Kota
Bharu and Hospital Universiti Sains Malaysia from I st January 2000 to 3I st Decetnber
2003. Additional follow up of one year after the recruittnent of the subjects was done
fron1 I st January 2004 to 3I st Decen1ber 2004. All patients who fulfilled the criteria were
included in the study. Hospital tnedical records and physician clinic records \Vere
reviewed by a researcher. The required inforn1ation on variables of interest and patients·
survival status until 31st December 2004 was recorded into a data collection forn1.
Telephone calls were also conducted to obtain the inforn1ation on survival status of son1e
patients who were discharged alive but loss to follow up.
RESULTS
The overall cumulative survival for hospitalized AMI in Kota Bharu were 91.0 (95o/o
confidence interval (CI): 87.6~ 93.5), 88.8 (95% CI: 85.2., 91.7)~ 86.6 (95o/o CI: 82.6~
89.7) and 83.9 (95% CI: 79.6, 87.5) percent for I day, 2 days, I week and I tnonth
respectively. The long-term survival rate for 6 months, I year, 2 years~ 3 years and 4
years after AMI were 80.7 (95% CI: 76.1. 84.6), 77.5 (95% CI: 72.6~ 81.7)~ 76.2 (95%
CI: 71.2. 80.6)~ 71.9 (95% CI: 66.0, 76.9) and 69.2 (95% CI: 62.7~ 74.8) percent
respectively.
Based on Cox Proportional Hazards Regression multivariable analysis after adjusting
other variables, the significant prognostic factors that influenced the risk of death in
hospitalized acute myocardial infarction patients in Kota Bharu were age at diagnosis
(HR=I.03. 95% CI: 1.01. 1.06). diabetes n1ellitus (HR=l.60, 95% CI: 1.03~ 2.46), left
ventricular failure (HR=2.15, 95% CI: 1.38, 3.34 ). thron1bolytic therapy (HR=0.48. 95°/o
CI: 0.3 L 0.73) and first contact of care (HR=0.47. 95% CI: 0.24. 0.91 ).
CONCLUSION
Survival rate of hospitalized AMI patients in the district of Kota Bharu was con1parable
with other developed countries. All significant independent prognostic factors identified
were considerably similar to other countries. except a few itnpot1ant factors such as
gender and drugs prescribed on discharge. Interestingly. first site contact of n1edical care
was also identified to significantly influence the risk of death of AMI in Kota Bharu.
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