OBJECTIVE
To compare the characteristics and survival of participants and nonparticipants in
a community-based study of myocardial infarction (MI).
PATIENTS AND METHODS
Residents of Olmsted County, MN, who presented with elevated cardiac troponin T levels
from September 1, 2002, through December 31, 2005, were prospectively enrolled and
classified with standardized criteria for MI. With specific Institutional Review Board
approval, the medical records of patients with MI who did not provide consent but
who had given general research authorization were reviewed, as was done for their
consenting peers.
RESULTS
During the study period, 2277 individuals with elevated cardiac troponin T levels
were approached, of whom 1863 (82%) consented to participate. Among the 414 nonparticipants,
375 (91%) had general research authorization. Of the 558 with general research authorization
who met the criteria for incident (ie, first-ever) MI, 67 (12%) refused to participate.
These participants tended to be older (mean ± SD age, 71±14 vs 67±15 years; P=.04), were more likely to be of races other than white (9% vs 2%; P=.01), and had more comorbidities, including peripheral vascular disease (P=.02), chronic pulmonary disease (P=.06), heart failure (P=.07), and impaired creatinine clearance (P=.02). No significant differences were detected in cardiovascular risk factors or
MI characteristics. During a median follow-up of 517 days, nonparticipants experienced
increased mortality rates compared with participants (hazard ratio, 1.97; 95% confidence
interval, 1.21-3.20), which was largely attributable to their older age and excess
comorbidities (adjusted hazard ratio, 1.43; 95% confidence interval, 0.86-2.35).
CONCLUSION
In this community-based study of MI, nonparticipants experienced worse survival rates
than participants largely because of differences in demographic and clinical characteristics.
These differences should be kept in mind when interpreting study results, particularly
if participation is low.
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Article info
Footnotes
This study was supported by a Postdoctoral Fellowship Award from the American Heart Association, Greater Midwest Affiliate (0525753Z), and grants from the Public Health Service and the National Institutes of Health (AR30582, R01 HL 59205, and R01 HL 72435). Dr Roger is an Established Investigator of the American Heart Association.
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© 2007 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
