Abstract 14970: Incidence, Predictors, and Long-Term Mortality of Recurrent Myocardial Infarction in Patients following Discharge for Acute Myocardial Infarction
Background: Procedural related factors including final coronary stenosis less than 30 %, residual coronary dissection and residual intracoronary thrombus have been reported to predict early occurrence of recurrent myocardial infarction (Re-MI) (within 30 days) in patients with acute myocardial infarction (AMI) who underwent percutaneous coronary intervention (PCI). However, there are few reports regarding incidence, predictors and long-term mortality of Re-MI after discharge for AMI in the PCI era.
Methods and Results: A total of 7,869 survived AMI patients who were registered in the Osaka Acute Coronary Insufficiency Study between 1998 and 2008 were studied. In the acute stage of AMI, 6,716 (85.3%) patients had received emergent PCI. During a median follow-up period of 3.9 years, 353 (4.5%) patients experienced Re-MI, with 7 (2.0%) of those dying within 30 days, which was classified as fatal Re-MI. Multivariate Cox regression analyses revealed that predictors of Re-MI were diabetes mellitus (HR, 1.817; 95% CI, 1.425-2.315; P<0.001), history of MI (HR, 1.577; 95% CI, 1.149-2.165; P=0.005), and advanced age (HR, 1.016; 95% CI, 1.004-1.028; P=0.009). These three predictors remained significant when angiographic and procedural parameters were incorporated into the analysis. The incidence (3.4%, 3.8%, 6.9%, and 11.1% for 0, 1, 2, and 3 factors, respectively, P<0.001) and adjusted risk of Re-MI increased when these variables were clustered. All-cause mortality rate was significantly higher in patients with Re-MI than those without (15.9% vs. 6.3%; HR, 2.010; 95% CI, 1.461-2.765, P<0.001).
Conclusions: In post-AMI patients treated in the PCI era, the incidence of Re-MI was relatively low compared to that reported previously. Patients’ clinical, rather than procedural, factors appear to affect the occurrence of Re-MI. Although nearly all Re-MI are non-fatal, Re-MI may place patients at a higher risk for subsequent mortality.
- © 2011 by American Heart Association, Inc.