Abstract P176: Does Family History of Coronary Artery Disease Affect Prognosis in Hospital Survivors of a First Acute Myocardial Infarction?

Abstract

Background: Family history (FH) of Coronary Artery Disease (CAD), a well known risk factor for development of CAD, is often elicited in patients presenting with acute myocardial infarction (MI). However, whether a positive FH determines prognosis following MI is unknown. Methods: In a prospective 24-center registry of AMI (Translational Research Investigating Underlying disparities in recovery from acute Myocardial infarction: Patients' Health status [TRIUMPH]), all hospital survivors of a first MI, aged <= 70 years were categorized either with a positive FH of CAD (N=800) or not (N=1993). Positive FH was defined as CAD in a father or brother <55 years of age or a mother or sister <65. Multivariable site-stratified proportional hazards regression, adjusting for GRACE risk score, tested the independent association of a FH of CAD with one year mortality. A subset analysis was performed of those patients who themselves presented with premature CAD (men<55 and women<65). Results: Patients with a FH of CAD were younger (53.2 vs. 54.9, p<.001), more were women (35.5% vs. 28%, p<.001), and white (69.8% vs. 65.9%, p<.01). They had a higher prevalence of dyslipidemia (46.5% vs. 41.2%, p<0.02) and were more likely to have prior angina (9.0% vs. 6.7%, p<0.05). They had lower baseline SF-12 Physical & Mental Component scores (p<.04) and lower Angina Quality of Life scores (p<.03). However, there were no differences in multivariable adjusted one year mortality observed in those with and without a positive FH of CAD (Hazard Ratio [HR] 1.34; 95% Confidence Interval [CI] 0.86-2.10). Similarly, there were no differences in one-year mortality when patients presenting with premature CAD were separated by FH status (HR 1.39; 95% CI 0.77-2.51). Conclusion: Although a positive FH of CAD is a predictor for developing CAD, it is not associated with prognosis after an initial MI. Therefore, the usefulness of including a FH of CAD in stratifying the post-MI population is unclear.