Abstract 13238: Persistence of High Rates of Major Adverse Cardiovascular Events at 1 Year Post-Myocardial Infarction in Patients With Multivessel Disease: A Systematic Literature Review

Abstract

Background: Multivessel disease (MVD) heightens the risk of major adverse cardiovascular events (MACE) in post-myocardial infarction (MI) patients. The risk of MACE is elevated in the early period after an MI, a period unaddressed by current secondary preventative therapies. Research aims: To better understand the impact of MVD on clinical and patient-centered outcomes post-MI in the current treatment landscape. Methods: A systematic literature review was conducted to identify relevant articles published between March 2019 and July 2022 from MEDLINE, Embase, Cochrane databases, and cardiovascular (CV) and health outcomes conferences. Articles reporting on pre-specified clinical or patient-centered outcomes in post-MI patients with MVD at timepoints within 1 year were included. Studies that included patients with cardiogenic shock were excluded from this review. Results: Clinical and patient-centered outcomes were reported in five randomized-controlled trials (RCTs) and 24 observational studies across 30 articles; and one RCT across two articles, respectively. Although the definition of MVD varied, it was generally characterized by ≥50% stenosis in ≥1 noninfarct-related coronary artery. Rates of individual MACE endpoints (all-cause mortality, CV mortality, MI, stroke) were variable (Table), likely due to heterogeneity in study populations and interventions. Nevertheless, a key trend was identified; MACE rates at 1-year post-MI were typically not substantially higher than those at earlier timepoints. EQ-5D scores, reflective of quality of life (QoL), increased following treatment; however, increases were marginal, indicating minimal improvements in QoL. Conclusions: MVD is associated with high rates of MACE early after MI that persist at 1 year. Novel therapies that address CV risk in the early period post-MI may support improved CV outcomes among patients with MVD. Further data on patient-centered outcomes are warranted.