Secondary prevention strategies after an acute ST-segment elevation myocardial infarction in the AMI code era: beyond myocardial mechanical reperfusion

Abstract

BackgroundThe AMI code is a regional network enhancing a rapid and widespread access to reperfusion therapy (giving priority to primary angioplasty) in patients with acute ST-segment elevation myocardial infarction (STEMI). We aimed to assess the long-term control of conventional cardiovascular risk factors after a STEMI among patients included in the AMI code registry.Design and methodsFour hundred and fifty-four patients were prospectively included between June-2009 and April-2013. Clinical characteristics were collected at baseline. The long-term control of cardiovascular risk factors and cardiovascular morbidity/mortality was assessed among the 6-months survivors.ResultsA total of 423 patients overcame the first 6 months after the STEMI episode, of whom 370 (87%) underwent reperfusion therapy (363, 98% of them, with primary angioplasty). At 1-year follow-up, only 263 (62%) had adequate blood pressure control, 123 (29%) had LDL-cholesterol within targeted levels, 126/210 (60%) smokers had withdrawn from their habit and 40/112 (36%) diabetic patients had adequate glycosylated hemoglobin levels. During a median follow-up of 20 (11–30) months, cumulative mortality of 6 month-survivors was 6.1%, with 9.9% of hospital cardiovascular readmissions. The lack of assessment of LDL and HDL-cholesterol were significantly associated with higher mortality and cardiovascular readmission rates.ConclusionsWhereas implementation of the AMI code resulted in a widespread access to rapid reperfusion therapy, its long-term therapeutic benefit may be partially counterbalanced by a manifestly suboptimal control of cardiovascular risk factors. Further efforts should be devoted to secondary prevention strategies after STEMI.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-017-0493-6) contains supplementary material, which is available to authorized users.

Pharmacological Treatment After Acute Coronary Syndrome: Baseline Clinical Characteristics and Sex Differences in a Population-Based Cohort Study.

“…With regard to socio-demographic characteristics, the proportion of men and women in our study is not balanced (28.7% of women) and it is similar to previous studies. [13,14,24,25] We found that women were older, had greater comorbidity at baseline and received more comedications after the study event than men, probably because they were older when had the rst ACS, as described in a similar cohort by Ribas et al [25] In agreement with similar studies, we found a higher prevalence of comorbidities in women, [26][27][28] while men had a higher prevalence of peripheral artery disease, [29] possibly related with the higher frequency of smoking habit.…”

Comparison of the pathways of care and life courses between first-time ST-elevation myocardial infarction (STEMI) and STEMI with prior MI: findings from the OSCAR registry

“…The literature stated that survivors of STEMI remained at high long-term risk of recurrent ischaemic cardiovascular events 20 21 and mortality, and demonstrated the effectiveness of patient education in decreasing the risk with changing the key lifestyle habits in particular smoking cessation 22 and control of the high density lipoproteinlevel. 21 The literature has also highlighted that secondary prevention strategies after a STEMI episode are still far from being optimal 23 and also denoted substantial problem of guidance documents for clinicians. 24 These results potentially counterbalance the prognostic benefits of the reperfusion therapy.…”

Ginsenoside Rb1 for Myocardial Ischemia/Reperfusion Injury: Preclinical Evidence and Possible Mechanisms

“…The direct cost of hospitalization in the United States is at least $450 billion and the loss of productive life years is also tremendous [2]. Prompt restoration of blood flow is crucial to salvage ischemic myocardium [3]. Reperfusion strategies such as primary percutaneous coronary intervention (PCI) and thrombolysis have shown to reduce mortality and infarct size and improve left ventricular function; however, reperfusion itself may result in adverse events [4].…”