Abstract
Current treatments for acute myocardial infarction (AMI) have dramatically improved clinical outcomes during the first year after AMI. Less is known, however, about the subsequent risks of recurrent cardiovascular events and mortality in patients who survive 1 year after AMI. The purpose of the present study is to evaluate long-term clinical outcomes in 1-year AMI survivors who were implanted with newer-generation drug-eluting stents (DESs) since 2010. The COREA-AMI (CardiOvascular Risk and idEntificAtion of potential high-risk population in AMI) registry consecutively enrolled AMI patients who underwent percutaneous coronary intervention (PCI), and patients who received newer-generation DESs since 2010 were analyzed. The primary endpoint was major adverse cardiovascular events (MACEs), and secondary endpoint was all-cause mortality. Of 6242 AMI patients, 5397 were alive 1 year after the index procedure. The cumulative incidence of MACEs and all-cause death 1 to 7 years after AMI were 28.4% (annually 4–6%) and 20.2% (annually 3–4%), respectively. Multivariate analysis showed that uncontrolled systolic blood pressure (SBP) and serum low-density lipoprotein cholesterol (LDL-C) concentration, as well as traditional risk factors, were associated with MACEs and all-cause death. Recurrent non-fatal myocardial infarction, ischemic stroke, and bleeding events within 1 year were significantly associated with all-cause death. The risks of adverse cardiovascular events and death remain high in AMI patients more than 1 year after the index PCI with newer-generation DESs. Traditional risk factors, uncontrolled SBP and LDL-C, and non-fatal adverse events within 1 year after the index procedure strongly influence long-term clinical outcomes.
Highlights
Acute myocardial infarction (AMI) is a common and fatal manifestation of ischemic heart disease
Kaplan-Meier analysis of all-cause death in men and women according to age found that the cumulative unadjusted risk of all-cause death in patients aged
The risk of all-cause death was significantly higher in men than in women aged ≥65 years, a difference that remained statistically significant after multivariate adjustment
Summary
Acute myocardial infarction (AMI) is a common and fatal manifestation of ischemic heart disease. AMI has been declining in most developed countries [3] These improvements have been attributed to many potential reasons, including the early diagnosis and treatment of AMI, the widespread use of cardiac catheterization and revascularization, the appropriate use of antithrombotics, secondary preventive therapies, development of the coronary care unit, and advances in critical care, as well as a decline in the prevalence of smoking and modifications in physical activities [3,4]. Despite these advances in diagnosis and management, AMI remains a major public health concern worldwide. Most AMI patients are implanted with newergeneration drug-eluting stents (DESs) and take guideline-directed medical therapy [14,15]
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