The underlying risk of death in the absence of treatment after a myocardial infarction (MI) is poorly documented. Methods: Analysis of 23 published studies in which 14211 patients were followed prospectively after MI; 6817 deaths were recorded. We restricted the analysis to studies in which follow-up was completed by 1980 to quantify the underlying risk in the absence of effective treatments. Results: After a first MI, on average, 23% of patients died before reaching the hospital and another

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... died during hospital admission; these rates increased with age. After hospital discharge cardiovascular mortality was approximately 10% in the first year and 5% per year thereafter, rates that were unrelated to age or sex. The yearly death rate of 5% persisted indefinitely; after 15 years, cumulative cardiovascular mortality was 70%. After a REPRINTED) ARCH INTERN MED/ VOL 162, NOV 25, 2002 WWW.ARCHINTERNMED.COM 2405