Incidence, predictors, and prognostic impact of recurrent acute myocardial infarction in China

Abstract

BackgroundIncidence, predictors, and prognostic impact of recurrent acute myocardial infarction (AMI) after initial AMI remain poorly understood. Data on recurrent AMI in China is unknown.MethodsUsing the China Patient-centred Evaluative Assessment of Cardiac Events (PEACE)-Prospective AMI Study, we studied 3387 patients admitted to 53 hospitals for AMI and discharged alive. The association of recurrent AMI with 1-year mortality was evaluated using time-dependent Cox regression. Recurrent AMI events were classified as early (1–30 days), late (31–180 days), and very late (181–365 days). Their impacts on 1-year mortality were estimated by Kaplan-Meier methodology and compared by the log-rank test. Multivariable modelling was used to identify factors associated with recurrent AMI.ResultsThe mean (SD) age was 60.7 (11.9) years and 783 (23.1%) were women. The observed 1-year recurrent AMI rate was 2.5% (95% CI 2.00 to 3.07) with 35.7% events occurring within the first 30 days. Recurrent AMI was associated with 1-year mortality with an adjusted HR of 25.42 (95% CI 15.27 to 42.34). Early recurrent AMI was associated with the highest 1-year mortality rate of 53.3% (log-rank p<0.001). Predictors of recurrent AMI included age 75–84, in-hospital percutaneous coronary intervention, heart rate >90 min/beats at initial admission, renal dysfunction, and not being prescribed any of guideline-based medications at discharge.ConclusionsOne-third of recurrent AMI events occurred early. Recurrent AMI is strongly associated with 1-year mortality, particularly if early. Heightened surveillance during this early period and improving prescription of recommended discharge medications may reduce recurrent AMI in China.

Current management and prognosis of patients with recurrent myocardial infarction

“…In a recent prospective cohort of 3387 patients, the average mortality rate at 1 year in re-MI patients was 32.2%, reaching 53.3% in those with early recurrences. In this population, re-MI was associated with a 25-fold increased risk of death at 1 year compared to patients with a single acute coronary event [19].…”

“…Older age has been shown to be significantly associated with re-MI in several studies [19,28] and is occasionally con-sidered as one of the most important predictive factors of re-MI [29,30]. Similar considerations may apply to diabetes [29][30][31], smoking status [32], female sex [28,31,33] or sociodemographic status [34].…”

“…In another study investigating readmissions in 296,965 US patients discharged after NSTEMI, 58.4% of total readmissions at 90 days were due to CV causes, with re-MI being the most frequent [17]. Notably, the risk of re-MI persists even at longer follow-up and re-MI rates actually tend to rise over the years after the index MI (13-16% at 7 years), though more than half of events occur within the first year [18,19].…”

Distribution, management and outcomes of AMI according to principal diagnosis priority during inpatient admission

“…Previous studies assessing AMI hospitalisations, their management and outcomes in different cohorts of patients have mainly focussed on primary AMI diagnosis. [2][3][4][5][6][7]16,17 However, the diagnosis priority as recorded administrative data may not necessarily reflect the acute cause of admission in these patients. Thus, failure to include patients with a secondary AMI diagnosis may result in the exclusion of a significant cohort of patients with AMI, leading to a significant underestimation of the AMI burden when evaluating in-hospital services as well as comorbid conditions and clinical outcomes associated with AMI.…”

Reduction in GLP-1 secretory capacity may be a novel independent risk factor of coronary artery stenosis

“…Recent development of pharmacological agents such as PCSK9 antibody and SGLT2 inhibitors have provided multiple options for control of risk factors in patients. On the other hand, more than 20% of patients with ST-elevation myocardial infarction (STEMI) do not have major risk factors of atherosclerosis 1 , 2 , and a significant proportion of patients with prior myocardial infarction have recurrent cardiovascular events despite guideline-based control of the risk factors, indicating the presence of “residual” risks 3 , 4 .…”