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Cost-benefit aspects of post-myocardial infarction intervention.

After myocardial infarction the mortality during the first post hospital year declines from approximately 10 per cent to 5 per cent during the second year. The rates of non-fatal recurrencies are similar. Mortality is related to age but not to the same extent to sex. Non-fatal recurrencies are, however, not related to age. Prediction of mortality is feasible by several prognostic models. Factors related to size of myocardial damage stand out as the important secondary risk factors for the years immediately after infarction. Most of these factors are not generally related to risk of non-fatal recurrencies. The proportion of cardiovascular deaths is 90 per cent during the first years and declines thereafter. Simplistically it may be said that the prognosis during the first years is related to the extent of the myocardial damage and thereafter primary risk factors become more important. Thus, it seems logical in the short-term perspective to influence myocardial factors and related arrhythmias and in the long-term perspective to influence primary risk factors which more likely operate on the vascular factors. Three preventive methods have demonstrated a positive benefit: 1) chronic beta-blockade, 2) cessation of smoking, 3) by-pass surgery in certain categories. After careful calculations it may be argued that at least half of the total mortality may be inhibited by beta-blockade and cessation of smoking. The impact of coronary surgery, lipid lowering and reduction of high blood pressures is more difficult to assess.