Abstract
Patients who have previously had a myocardial infarction (MI) are considered a high-risk group with increased risk for cardiovascular (CV) events. During the last decade, the outcome of acute coronary syndrome (ACS) patients has improved due to advances in medical therapy and interventional techniques. We aimed to examine temporal trends and outcomes of patients with prior MI admitted due to ACS from the Acute Coronary Syndrome Israeli Survey (ACSIS). Included were 16,934 ACS patients, of whom 31.4% had prior MI. For temporal trend analysis, the cohort was divided into an early period (2000–2008) and late period (2010–2018). For patients with prior MI, patients in the late period had a higher rate of CV risk factors and were treated more frequently with revascularization and guidelines-directed medical therapy. Recurrent MI (6.7% vs. 12%, p < 0.001), MACE (10.6% vs. 21%, p < 0.001) and 1-year mortality (10.7% vs. 14.6%, p < 0.001) were significantly lower in the late period. However, the mortality rate for patients with prior MI remained higher compared with patients without prior MI (10.7% vs. 6.8% p < 0.001) with an overall higher mortality rate in the STEMI group. Thus, despite significant improvement in outcome measures in the contemporary era, ACS patients with prior MI are still at increased risk for recurrent ischemic CV events and mortality.
Highlights
Patients who have previously had a myocardial infarction (MI) are at increased short and long-term risk for cardiovascular (CV) events, including recurrent MI and CV mortality [1,2,3,4,5,6,7]
Between 2000–2018, 16,934 patients were enrolled in the Acute Coronary Syndrome Israeli Survey (ACSIS) registry, of whom 5317 (31.4%) had a prior MI
The current study investigated temporal trends among patients with prior MI from a large multicentre acute coronary syndrome (ACS) registry and found several important findings as follows: (1)~1/3 of patients with ACS had a history of prior MI, most of them presented with NSTEMI-ACS, (2) this high-risk group had higher rates of CV events and mortality up to one year of follow up, (3) despite improved ACS management over time with more invasive coronary revascularization procedures, guidelines-directed medical treatment, and rehabilitation programs, patients with prior MI still had worse CV outcomes, and (4) after a propensity matching statistical adjustment, mortality rates of patients with prior MI remained unchanged over time, and the worst outcome was observed in those prior MI patients presenting with ST elevation MI (STEMI)
Summary
Patients who have previously had a myocardial infarction (MI) are at increased short and long-term risk for cardiovascular (CV) events, including recurrent MI and CV mortality [1,2,3,4,5,6,7]. Secondary prevention programs, intensified follow up, long term medical treatment, and cardiac rehabilitation programs are mandatory to reduce the risk of recurrent CV events. There has been a rapid and significant improvement in the prognosis of patients with ACS due to advancements in drug therapy and interventional techniques [8,9,10]. It is not well established whether similar trends exist in ACS patients who had a prior MI, a high-risk group. We aimed to examine temporal trends in the prevalence, characteristics, treatment strategies, and clinical outcomes of patients with prior MI who were admitted to Israeli medical centres due to ACS
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