Abstract
Introduction: Long-term disease progression post myocardial infarction (MI) is inadequately understood and recurrences appear at the stented lesion or in untreated progressive lesions. Hypothesis: We studied the pattern and angiographic properties (culprit/non-culprit) of recurrent-MI (re-MI) in a large real-world patient population. Methods: We performed a prospective cohort study in 99,546 first-occurrence MI patients enrolled in Swedish Web system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) between 1 Jan 2006 and 31 Dec 2014. Results: A culprit lesion could be identified in 41,006 patients who underwent coronary angiography. Of those, 2,361 patients suffered a re-MI where the angiography could detect the infarct origin: 587 originated from the culprit lesion- and 1,774 from the non-culprit lesion. The cumulative event probability for re-MI within 8 years (estimated by Kaplan-Meier) related to the culprit lesion was 0.027 (0.023-0.030) as compared with 0.080 (0.075-0.085) for a non-culprit lesion (Figure). At the index infarction, patients with subsequent culprit vs. non-culprit re-MIs were overall similar according to baseline characteristics: gender (men: 69% vs. 72%), age (66 vs. 65 years), infarction type (STEMI: 54% vs. 52%), diabetic status (22% vs. 21%), current smoking (32 % vs. 30 %), hyperlipidemia (statin treatment: 20 vs. 23 %) and hypertension (44.1% vs. 47.5%). Patients with culprit re-MIs were somewhat less likely to have 3-vessel disease at index (12% vs 17%) but procedural characteristics such as number of stents, total stent length and mean stent diameter were similar between groups. Conclusions: In a large cohort of first-occurrence MI patients undergoing PCI, the risk of reinfarction not originating from a previously stented lesion was three times higher than the risk of lesions originating from a previously stented lesion.
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