Prognostic Impact of Previous Atherosclerotic Cardiovascular Disease on Short- and Long-Term Outcomes in Acute Myocardial Infarction

Abstract

Patients with previous atherosclerotic cardiovascular disease (ASCVD) are typically managed by secondary prevention modalities, but they may experience recurrent events. In acute myocardial infarction (MI), the prognostic effect of pre-existing ASCVD on short- and long-term outcomes remains uncertain. This retrospective multicenter registry included 2475 patients with acute MI who had undergone percutaneous coronary intervention. Previous ASCVD was defined as a history of ischemic events in the coronary, cerebral, and peripheral arterial territories. Patients were divided into 2 groups according to pre-existing ASCVD. The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, recurrent MI, and ischemic stroke during hospitalization and after discharge. The bleeding outcomes were also evaluated. Of the 2475 patients, 475 (19.2%) had previous ASCVD. Patients with previous ASCVD were older and likely to have more comorbidities than those without ASCVD. During hospitalization, MACE rates were higher in the ASCVD group than in the non-ASCVD group (16.4% vs. 9.6%, p<0.001). Similarly, during a median follow-up of 542 days after discharge, patients with previous ASCVD had an increased risk of MACE than those without ASCVD (13.4% vs. 5.6%, p<0.001). Multivariable analyses identified previous ASCVD as a factor that was significantly associated with MACE after discharge. Major bleeding events occurred more frequently in the ASCVD group than in the non-ASCVD group. In conclusion, pre-existing ASCVD was often observed in patients with acute MI and was particularly associated with long-term ischemic outcomes after discharge; thus, further clinical investigations are needed in this vulnerable patient subset.