Long-Term Cardiovascular Risk Following MI | Journal Scan

Study Questions:

What is the risk of subsequent cardiovascular events in patients discharged after myocardial infarction (MI)?

Methods:

This was an observational, retrospective cohort study in which data were analyzed from mandatory Swedish national registries. The study population was patients discharged with a diagnosis of acute MI between 2006 and 2011 and alive 1 week after discharge. A stable post-MI population was defined as patients who were alive and did not experience a recurrent MI or stroke during the first 365 days post-index MI. The primary endpoint was a composite of nonfatal MI, nonfatal stroke, or cardiovascular death. The frequency of the composite endpoint was assessed at two time points: first 365 days after index MI and from day 366 to the end of study follow-up in the stable post-MI population.

Results:

The analytic sample included 97,254 patients who were alive 1 week after discharge. In the stable post-MI population, the mean duration of follow-up was 2.54 years. The risk of the composite endpoint during the first 365 days post-index MI was 18.3%. In the stable post-MI population, the cumulative probability of a subsequent event was 9.0% and 20.0% after 12 and 36 months, respectively. The following variables were associated with a higher risk of ischemic events or death: age, prior MI, stroke, diabetes, heart failure, and no index MI revascularization.

Conclusions:

In the year following discharge from a hospitalization for acute MI, one in five patients had a subsequent cardiovascular event.

Perspective:

This is an important study that draws attention to the significant risk of cardiovascular events following hospitalization for acute MI. The risk of ischemic events or death is substantial both in the year following MI and in the time period following the first year. Future studies should characterize strategies that may mitigate this risk. In particular, the authors posit that ‘prolonged effective prevention programs and sustained contact with a cardiologist’ may be necessary to minimize subsequent cardiovascular events.

Clinical Topics: Acute Coronary Syndromes, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure

Keywords: Myocardial Infarction, Diabetes Mellitus, Heart Failure, Acute Coronary Syndrome, Stroke, Risk, Hospitalization, Follow-Up Studies, Retrospective Studies, Registries, Primary Prevention, Secondary Prevention


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