Abstract
Introduction: Long-term prognosis of myocardial infarction (MI) is still serious, especially in patients with MI and cardiogenic shock. To improve long-term prognosis and prevent recurrent events, sustainable cardiovascular risk factor control (RFC) after MI is crucial. Methods: The article gives an overview on health care data regarding RFC after MI and presents recent trials on modern preventive strategies that support patients to achieve risk factor targets during long-term course. Results: International registry studies, such as EUROASPIRE, observed alarming deficiencies in RFC after MI. As data of the German Bremen ST-segment elevation myocardial infarction (STEMI)-Registry show, most deficiencies are found in socially disadvantaged city districts and in young patients. Several studies on prevention programmes to improve RFC after MI reported inconsistent data; however, in the recently published IPP trial a 12-months intensive prevention programme that included both repetitive personal contacts with non-physician prevention assistants and telemetric risk factor control, was associated with significant improvements of numerous risk factors (smoking, LDL and total cholesterol, systolic blood pressure and physical inactivity). Conclusions: There is a strong need of action to improve long-term risk RFC after MI, especially in socially disadvantaged patients. Modern prevention programmes, using personal and telemetric contacts, have large potential to support patients in achieving long-term risk factor targets after coronary events.
Highlights
IntroductionDespite decreasing mortality rates in the last decades, long-term prognosis after myocardial infarction (MI) is still serious [1,2,3]
Long-term prognosis of myocardial infarction (MI) is still serious, especially in patients with MI and cardiogenic shock
The highest mortality was observed in patients with cardiogenic shock complicating acute segment elevation myocardial infarction (STEMI) with an in-hospital mortality rate of 38% and a one-year mortality rate of 50%, with a decrease of mortality rates during the period from 2006 to 2013 [3]
Summary
Despite decreasing mortality rates in the last decades, long-term prognosis after myocardial infarction (MI) is still serious [1,2,3]. Comparing the RESPONSE II [23] and the IPP [24] trial, both studies investigated a modern long-term prevention programme after acute coronary syndromes and evaluated “prevention success” and “prevention failure” after 12 months. In the RESPONSE II study only body weight was significantly reduced, while the risk factors smoking and physical inactivity were not improved (nor was LDL cholesterol) The comparison of both studies demonstrates that the focus of preventive programmes (e.g., weight reduction or lipid-lowering) has strong implications on achieved prevention results. In a further subanalysis it was observed that MI-patients with low school-leaving qualifications had more risk factors at time of MI than patients with higher school graduations; patients with lower school-leaving qualifications showed a greater improvement of risk factor profile by the long-term prevention programme compared to the patients with higher school graduations [26] These data support preventive strategies that focus on patients with lower educational or socioeconomic status
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