Abstract
Recurrent acute myocardial infarctions (AMI) are common and associated with dismal outcomes. We evaluated the clinical characteristics and the prognosis of AMI survivors according to the number of recurrent AMIs (ReAMI) and the time interval of events (TI). A retrospective analysis of patients who survived following hospitalization with an AMI throughout 2002–2017 was conducted. The number of ReAMIs for each patient during the study period was recorded and classified based on following: 0 (no ReAMIs), 1, 2, ≥3. Primary outcome: all-cause mortality up to 10 years post-discharge from the last AMI. A total of 12,297 patients (15,697 AMI admissions) were analyzed (age: 66.1 ± 14.1 years, 68% males). The mean number of AMIs per patient was 1.28 ± 0.7; the rates of 0, 1, 2, ≥3 ReAMIs were 81%, 13.4%, 3.6% and 1.9%, respectively. The risk of mortality increased in patients with greater number of AMIs, HR = 1.666 (95% CI: 1.603–1.720, p < 0.001) for each additional event (study group), attenuated following adjustment for potential confounders, AdjHR = 1.135 (95% CI: 1.091–1.181, p < 0.001). Increased risk of mortality was found with short TI (<6-months), AdjHR = 2.205 (95% CI: 1.418–3.429, p < 0.001). The risk of mortality following AMI increased as the number of ReAMIs increased, and the TI between the events shortened. These findings should guide improved surveillance and management of this high-risk group of patients (i.e., ReAMI).
Highlights
Throughout the recent decades, multiple significant advancements in the management of patients with an acute myocardial infarction (AMI) were introduced and led to improved short- and long-term outcomes [1–4]
The objective of the current study was to evaluate the clinical characteristics and the prognosis of AMI survivors with recurrent acute myocardial infarction (ReAMI) according to the number of events and the time interval between events (TI)
Patients were excluded due to the following criteria: (1) patients who were not residents of Southern District of Israel, (2) patients with a history of an MI prior to the earliest AMI event throughout the study period, (3) patients who died during their first admission during the study period and (4) AMI events that occurred within 28 days or less after a previous AMI
Summary
Throughout the recent decades, multiple significant advancements in the management of patients with an acute myocardial infarction (AMI) were introduced and led to improved short- and long-term outcomes [1–4]. AMI survivors remain at increased risk of various adverse outcomes, including a recurrent AMI (ReAMI) [5,6]. 10% of patients are at risk of developing a ReAMI, accounting for about 200,000 cases per year in the United States [5–10]. ReAMIs are reported to be associated with worse outcomes [5,6,9,10]. Previous reports often consisted of relatively short follow-up for ReAMIs or outcomes, were not contemporary and did not evaluate patients with multiple ReAMIs. The objective of the current study was to evaluate the clinical characteristics and the prognosis of AMI survivors with ReAMIs according to the number of events and the time interval between events (TI)
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