Abstract
BackgroundPatients with established coronary artery disease (CAD) have an increased risk of new cardiovascular events. An underuse of secondary preventive drugs has been observed, and many patients may not attain the treatment goals for secondary prevention. The aims of the present nationwide register-based cohort study were to assess the degree of risk factor control and long-term outcomes in patients < 80 years with Type 1 myocardial infarction (MI) with and without prior CAD.MethodsData concerning all patients with MI admitted to hospitals in Norway from 2013 to 2016 were retrieved from the Norwegian Myocardial Infarction Register (NORMI). Long-term mortality was obtained through linkage with the Norwegian Cause of Death Registry.ResultsIn total, 47,204 patients were registered in the NORMI from 2013 to 2016. Prior CAD was recorded in 7219 (25.2%) of the 28,607 patients < 80 years old with Type 1 MIs. On average, 3 of the 6 defined treatment targets for secondary preventive therapy were attained, and only 1% of the patients achieved all targets. Patients with MI and prior CAD had increased risk of death or new MI compared to patients without prior CAD during long-term follow-up (adjusted HR 1.6, 95% CI 1.5–1.7).ConclusionsPrior CAD was frequent in patients with acute MI. The attainment of secondary preventive treatment targets in patients with MI and prior CAD was not optimal, and the long-term outcomes were reduced compared to patients without prior CAD. Increased efforts to improve risk factor control are needed.
Highlights
Patients with established coronary artery disease (CAD) have an increased risk of new cardiovascular events
The aims of the present study were to investigate the degree of risk factor control in a nationwide cohort of all patients admitted to hospitals in Norway with acute myocardial infarction (MI) and prior CAD, and to study long-term outcomes in these patients compared to patients with acute MI but without prior CAD
During the period 2013–2016, 47,204 patients were registered in the Norwegian Myocardial Infarction Register (NORMI)
Summary
Patients with established coronary artery disease (CAD) have an increased risk of new cardiovascular events. The aims of the present nationwide register-based cohort study were to assess the degree of risk factor control and long-term outcomes in patients < 80 years with Type 1 myocardial infarction (MI) with and without prior CAD. Patients with established coronary artery disease (CAD), defined as prior myocardial infarction (MI), percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), have a high risk of new cardiovascular events or death [2]. All patients with diagnosed CAD should be given advises regarding therapeutic lifestyle changes, Jortveit et al BMC Cardiovascular Disorders (2019) 19:71 goals for secondary prevention [10,11,12,13]. In Norway, national health registers with mandatory registration by law and almost complete follow-up provide an opportunity to study a nationwide and unselected patient population
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