Incidence, Characteristics, and Management of Patients with Recurrent Myocardial Infarctions: Insights from the EYESHOT POST-MI

Abstract

Background. It is unknown whether patients who survived two or multiple episodes of myocardial infarction (MI) present different clinical characteristics and management than patients at their first MI. Methods. The EYESHOT post-MI was a prospective, observational, nationwide study aimed to evaluate the management of patients presenting to cardiologists 1 to 3 years from the last MI event. In 3 months of enrolment, 165 Italian cardiology centers included 1633 consecutive post-MI patients. In the present analysis, we stratified the study cohort according to the number of prior MI episodes (i.e., 1, 2 or ≥3). Results. Among the 1618 patients enrolled with complete data on MI history, 1335 (82.5%) were at their first MI episode, 209 (12.9%) had a history of 2 MIs, and the remaining 74 (4.6%) had ≥ 3 prior MIs. Patients with a history of multiple MIs were increasingly older and presented a significantly higher rate of risk factors compared to those at their first MI. During the year prior to enrolment, patients with 2 or ≥3 MI episodes more frequently underwent coronary angiography compared to the other group ( p < 0.0001 ). In addition, several lifesaving and antianginal drugs were more frequently prescribed in patients presenting with a history of multiple MIs compared to those at their first MI. Conclusions. Our data suggest that patients with multiple MIs managed by cardiologists in routine clinical practice present an incremental clinical risk, more frequently undergo coronary angiography, and are more intensively managed with pharmacological therapies compared to patients at their first MI episode.

Risk stratification and secondary prevention post-myocardial infarction: insights from the EYESHOT Post-MI study

“…Despite guideline recommendations, 22 our data demonstrated an inappropriate use of the higher dose of ticagrelor 1 year after MI and an underuse of 60 mg twice a day. As outlined in a previous analysis of the EYESHOT Post-MI registry, 6 Italian physicians do not tend to continue DAPT after 1 year from acute coronary syndromes, even in the highest risk patients, thus outlining the need to better implement guideline recommendations in clinical practice 6 . However, the overall rate of our patient population who were taking DAPT beyond at least 1 year was higher than the rate of DAPT continuation beyond 1 year in the European TIGRIS registry 23 population (29 vs. 12%) but lower than the rate reported in the EPICOR Asia study at 2 years from the acute event (62%) 24 .…”

“…The EYESHOT Post-MI study is an Italian registry that included a large number of patients, 1–3 years after a MI event 5,6 . This national database shed light on the real-world implementation of clinical interventions in post-MI patients.…”

“…The methods used for the EYESHOT Post-MI study have been previously described in detail 5,6 . Briefly, the EYESHOT Post-MI study was a prospective, observational, nationwide registry of consecutive patients with a prior MI who were managed by cardiologists.…”

“…Over this period, 1633 consecutive patients were enrolled in 165 cardiology centers. Most patients (84%) were enrolled during outpatient or day hospital visits, with the remaining (16%) enrolled during hospital admissions 5,6 . Data were collected using a web-based, electronic case report form, with the central database located at the ANMCO Research Center.…”

ANMCO position paper on the management of hypercholesterolaemia in patients with acute coronary syndrome

“…The latter had more risk factors and were older than patients at their first ACS event. 92 According to registries conducted in cardiology intensive care units, patients aged ≥ 75 years represent ∼30% of patients with an ST-segment elevation ACS and 40% of those without ST-segment elevation ACS. 3 , 93–95 These data underestimate the true number of elderly patients with ACS since more than 17% of these patients are admitted to non-cardiac wards.…”