Yang XD et al. In-hospital mortality in patients with AMI 33 Figure 1. Survival rates of AMI patients with or without comorbidities. real-world setting. The present study showed that 74.6% of the AMI patients had at least one comorbidity, with hypertension, diabetes mellitus and old myocardial infarction as the most common comorbidities at admisssion. The number of comorbidities increased with increasing age. It was reported that age,[9,10] gender,[1014] percutaneous coronary intervention[15] and heart failure[16] might be the prognostic factors for the early outcome of patients with AMI. Therefore, in the present study, these four factors were adjusted in Cox regression analysis. Our study showed that the 30-day in-hospital mortality in AMI patients with only one comorbidity at admission (7.2%) were higher compared with that in patients without comorbidity (4.9%), but the difference was not statistically significant (RR: 1.21, 95% CI: 0.901.64, P = 0.209). Compared with patients without comorbidity, the 30-day in-hospital mortality with 2 comorbidities (11.1%) were significantly higher (RR: 1.41, 95% CI: 1.131.77, P = 0.003); the 30-day in-hospital mortality in AMI patients with 3 or more comorbidities (20.3%) was even higher (RR: 1.95, 95% CI: 1.592.39, P = 0.000). These results suggested that AMI patients with more comorbidities were more likely to have higher 30-day in-hospital mortality, and the number of medical comorbidities might be predictive for the early mortality rate of patients. The number of medical comorbidities at admission might be a simple and easy way for heath care professionals to predict the early mortality rate for patients admitted with AMI. How many problems are on the problem list? How many prescription medications does the patient take? After detailed history taking and physical examination, the clinicians might obtain the information on the medical comorbidities without much difficulty. Based on the number of medical comorbidities at admission, the clinicians might preliminarily assess the risk of 30-day in-hospital mortality. Special attention should be paid to those patients with 3 or more comorbidities, whose 30-day in-hospital mortality rate might be high, and medical therapy and nursing care should be intensified and their medical condition should be carefully observed. The health care professionals should also bear in mind that chronic medical comorbidities might have an impact on physicians’ decision making regarding standard therapeutic options for AMI. Complete adherence to therapeutic guidelines for AMI is suboptimal in patients with comorbidities. As a result, patients with more severe comorbidities were less likely to receive evidence-based medications or percutaneous coronary intervention recommended by AMI treatment guideline.[1719] For example, β blockers might be underused in AMI patients complicated with chronic obstructive pulmonary disease. Therefore, the physicians should evaluate multiple organ functions to ascertain whether there were any contraindications for standard therapy recommended by AMI treatment guideline. On the other hand, less medical and nursing services might be considered for AMI patients without comorbidity or with a single comorbidity, so as to reduce the medical burden of the patients. 4.1 Study limitations In the present study, the effect of comorbid conditions on short-term outcome of patients with AMI were gauged by counting the number of comorbidities. However, a simple count of medical comorbidities implicitly assumed that the 30-day mortality of AMI patients was equally affected by hypertension as by valvular heart disease, which seemed implausible. A better method would be to construct an index that weighed medical comorbidities according to their impact on 30-day in-hospital mortality so that hypertension counted more heavily than valvular heart disease. Therefore, a properly weighted index would be built to precisely measure the effects of medical comorbidities on 30-day in-hospital mortality, which might help in clinical practice. In conclusion, this retrospectively study provided evidence that AMI patients with more comorbidities were more likely to have 30-day in-hospital mortality. However, further studies are needed to construct a properly weighted index to precisely measure the association between medical comorbidities at admission and 30-day in-hospital mortality in patients with AMI. References 1 Kumar A, Cannon CP. Acute coronary syndromes: diagnosis http://www.jgc301.com; jgc@mail.sciencep.com | Journal of Geriatric Cardiology