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Survival prospects after acute myocardial infarction in the UK: a matched cohort study 1987–2011
  1. Lisanne A Gitsels1,
  2. Elena Kulinskaya1,
  3. Nicholas Steel2
  1. 1School of Computing Sciences, University of East Anglia, Norwich Research Park, Norwich, UK
  2. 2Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
  1. Correspondence to Lisanne A Gitsels; l.gitsels{at}


Objectives Estimate survival after acute myocardial infarction (AMI) in the general population aged 60 and over and the effect of recommended treatments.

Design Cohort study in the UK with routinely collected data between January 1987 and March 2011.

Setting 310 general practices that contributed to The Health Improvement Network (THIN) database.

Participants 4 cohorts who reached the age of 60, 65, 70, or 75 years between 1987 and 2011 included 16 744, 43 528, 73 728, and 76 392 participants, respectively. Participants with a history of AMI were matched on sex, year of birth, and general practice to 3 controls each.

Outcome measures The hazard of all-cause mortality associated with AMI was calculated by a multilevel Cox's proportional hazards regression, adjusted for sex, year of birth, socioeconomic status, angina, heart failure, other cardiovascular conditions, chronic kidney disease, diabetes, hypertension, hypercholesterolaemia, alcohol consumption, body mass index, smoking status, coronary revascularisation, prescription of β-blockers, ACE inhibitors, calcium-channel blockers, aspirin, or statins, and general practice.

Results Compared with no history of AMI by age 60, 65, 70, or 75, having had 1 AMI was associated with an adjusted hazard of mortality of 1.80 (95% CI 1.60 to 2.02), 1.71 (1.59 to 1.84), 1.50 (1.42 to 1.59), or 1.45 (1.38 to 1.53), respectively, and having had multiple AMIs with a hazard of 1.92 (1.60 to 2.29), 1.87 (1.68 to 2.07), 1.66 (1.53 to 1.80), or 1.63 (1.51 to 1.76), respectively. Survival was better after statins (HR range across the 4 cohorts 0.74–0.81), β-blockers (0.79–0.85), or coronary revascularisation (in first 5 years) (0.72–0.80); unchanged after calcium-channel blockers (1.00–1.07); and worse after aspirin (1.05–1.10) or ACE inhibitors (1.10–1.25).

Conclusions The hazard of death after AMI is less than reported by previous studies, and standard treatments of aspirin or ACE inhibitors prescription may be of little benefit or even cause harm.

  • All-cause mortality

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  • Contributors LAG implemented the statistical methods, analysed the data, and wrote the first version of the manuscript. EK designed the study, provided guidance on the statistical methods and interpretation of the results, and contributed to the writing of the manuscript. NS formulated the research questions, provided guidance on the analysis and implications of results, and contributed substantially to the writing of the final version of the manuscript.

  • Funding Access to The Health Improvement Network (THIN) database was funded by the University of East Anglia. The work by the first two authors was in part funded by the Economic and Social Research Council (grant number ES/L011859/1).

  • Competing interests None declared.

  • Ethics approval This study was approved by the Scientific Review Committee on the 16th of June 2014 (reference number 14-043).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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