Factors associated with recurrent myocardial infarction within one year after acute myocardial infarction

doi:10.1016/0002-8703(91)90712-Q

American Heart Journal

Volume 121, Issue 2, Part 1, February 1991, Pages 457-465

https://doi.org/10.1016/0002-8703(91)90712-Q Get rights and content

Abstract

In a large population of patients (n = 3666) who were discharged from the hospital after acute myocardial infarction and followed up for 1 year, factors associated with recurrent nonfatal (n = 171) or fatal (n = 74) infarction were identified. Also, the effects of combining various end points (recurrent nonfatal or fatal infarction and other cardiac death) in multivariate analyses, a practice common in many small studies that evaluate the predictive value of various treatments or special tests, was examined. In univariate analyses, patients with nonfatal recurrent infarction did not differ with respect to age or gender from infarct-free survivors, but they more often had a history of previous myocardial infarction, congestive heart failure, angina pectoris, and diabetes; more severe pulmonary congestion was present on chest x-ray during the admission, and a non-Q wave index infarction was more frequent. Patients with either a fatal or nonfatal recurrent infarction had more angina pectoris during follow-up (55% to 60%) compared with 27% in event-free survivors and 31% in patients who died of other cardiac causes in whom this factor could be assessed before death. In multivariate analyses, historical and clinical prognostic factors were ranked differently for fatal or nonfatal reinfarction and other cardiac causes of death; angina pectoris at follow-up was highly related to recurrent infarction (fatal or nonfatal), along with a history of diabetes, and a non-Q wave index infarction. These factors were not independently related to other causes of cardiac death. When angina pectoris at follow-up was used in the multivariate analysis of recurrent infarction (fatal plus nonfatal), it was the most important factor. This finding supports the general practice of referring patients with angina pectoris during follow-up (34% of the population) for coronary angiography in an effort to identify those with severe disease who might benefit from revascularization, which is aimed at the prevention of recurrent myocardial infarction.

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Cited by (39)

Reinfarction as a complication of acute myocardial infarction. PRIMVAC registry data
2005, Revista Espanola de Cardiologia
El perfil clínico de los pacientes con infarto agudo de miocardio (IAM) que presentan un reinfarto (REIAM) durante su estancia en la unidad de cuidados intensivos cardiológicos (UCIC) es poco conocido. El objetivo de este trabajo es determinar los factores predictores de REIAM, su incidencia global y su mortalidad.
Se incluyó a todos los pacientes con IAM ingresados en las UCIC de 17 hospitales de la Comunidad Valenciana en el período 1995-2000. Se determinaron las características diferenciales de los pacientes con y sin REIAM, y se calcularon las odds ratio y sus intervalos de confianza del 95% mediante un análisis de regresión logística para los posibles factores predictores.
Se incluyó a 12.071 pacientes con IAM. La edad media fue de 65,5 años, la proporción de mujeres del 23,8% y la incidencia de REIAM del 2,8%. La edad fue significativamente mayor en el grupo con REIAM que en el grupo sin REIAM, al igual que el porcentaje de mujeres. Se realizaron más procedimientos, se utilizaron más fármacos y hubo más complicaciones en el grupo con REIAM. La mortalidad fue significativamente mayor en el grupo con REIAM (37,8 frente a 12,6%). La edad, la diabetes mellitus, el infarto de miocardio previo y el desarrollo de onda Q en el electrocardiograma se asociaron de forma independiente con la presencia de REIAM.
El REIAM en la UCIC conlleva una alta mortalidad. Algunos factores presentes en las primeras horas del IAM se asocian con la aparición de REIAM.
The clinical profile of patients with acute myocardial infarction (AMI) who have reinfarction (REAMI) during their stay in the intensive cardiologic care unit (ICCU) is not well known. The aim of this study was to identify factors predictive of REAMI, as well as its global incidence and mortality.
All patients with AMI admitted to the ICCU of 17 hospitals in the Comunidad de Valencia (Spain) in the period 1995-2000 (PRIMVAC Registry) were included. Differential characteristics between patients with or without REAMI were determined, and odds ratios (OR) for possible predictive factors were estimated with their 95% confidence intervals by logistic regression.
A total of 12 071 patients were included. Mean age of the patients was of 65.5 years, the percentage of women was 23.8%, and the incidence of REAMI was 2.8%. The REAMI group was significantly older than the non-REAMI group. Female sex was significantly more common in the REAMI group. More diagnostic and therapeutic procedures were carried out, more drugs were used and there were more complications in the REAMI group. Mortality was significantly higher in the REAMI group (37.8% vs 12.6%). Only age, diabetes mellitus, previous myocardial infarction and the appearance of Q waves in the electrocardiogram were independently associated with the presence of REAMI.
REAMI in the ICCU was associated with high mortality. Some clinical factors present during the first few hours after AMI were associated independently with the appearance of REAMI.
The incidence, predictors, and outcomes of early reinfarction after primary angioplasty for acute myocardial infarction
2003, Journal of the American College of Cardiology
We sought to identify the incidence, predictors, and clinical consequences of one-month reinfarction (RE-MI) in patients undergoing primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI).
One-month reinfarction after AMI significantly increases long-term mortality; however, little is known about the incidence and predictors of RE-MI in patients undergoing primary angioplasty.
We analyzed data from 3,646 patients who underwent primary PCI in the Primary Angioplasty in Acute Myocardial Infarction (PAMI) studies. We studied the incidence, correlates, and clinical outcomes of 30-day RE-MI.
Reinfarction within one month of index hospitalization occurred in 77 (2.1%) of patients. In multivariate analysis, admission Killip class >1 (odds ratio [OR] 2.02, 95% confidence interval [CI] 1.09 to 3.76), left ventricular ejection fraction <50% (OR 2.49, 95% CI 1.30 to 4.74), final coronary stenosis >30% (OR 2.57, 95% CI 1.28 to 5.15), and presence of coronary dissection (OR 2.40, 95% CI 1.36 to 4.24) and thrombus (OR 2.36, 95% CI 1.23 to 4.53) on the final angiogram were independent correlates of RE-MI. One-month reinfarction was independently associated with death (OR 7.14, 95% CI 3.28 to 15.5) and ischemic target vessel revascularization (I-TVR) (OR 15.0, 95% CI 8.68 to 26.0) at six months.
We conclude that, although early RE-MI is uncommon in patients treated by primary PCI, it is a significant independent predictor of death and I-TVR at six months. Admission Killip class >1 and left ventricular systolic dysfunction were associated with higher incidence of RE-MI. Our results suggest that optimal revascularization during primary PCI may decrease RE-MI rates.
Incidence, determinants, and clinical course of reinfarction in-hospital after index acute myocardial infarction (results from the pooled data of the Maximal Individual Therapy in Acute Myocardial Infarction [MITRA], and the Myocardial Infarction Registry [MIR])
2001, American Journal of Cardiology
Citation Excerpt :
Only female gender in the multivariate analysis was still a statistically independent determinant. In accordance to our findings, other studies found no independent association for systemic hypertension13 and diabetes mellitus2,3,11 with reinfarction. Our data indicate that an anterior location of the index AMI and heart failure at admission were not independent determinants of RE-AMI.
There are few data about the incidence, determinants, and clinical course of in-hospital repeat acute myocardial infarction (RE-AMI) after an index AMI. From June 1994 to June 1998, 22,613 patients with AMI as an index event were registered by the Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) and Myocardial Infarction Registries (MIR). Of these, 1,071 (4.7%) had a RE-AMI. For the index event, 9,143 patients (40.5%) were treated with thrombolysis, 1,707 (7.5%) with primary angioplasty, and 443 (2.0%) with a combination of both. Multivariate analysis showed that previous AMI (odds ratio [OR] 1.59; 95% confidence intervals [CI] 1.35 to 1.86), age >70 years (OR 1.57; 95% CI 1.36 to 1.81), diagnostic first electrocardiogram (OR 1.37; 95% CI 1.19 to 1.59), and female gender (OR 1.14; 95% CI 1.05 to 1.32) were independently associated with a higher incidence of RE-AMI. The incidence of RE-AMI was higher when patients received thrombolysis (OR 1.36; 95% CI 1.15 to 1.61), and it was lower when they underwent primary angioplasty (OR 0.74; 95% CI 0.53 to 1.03) or received β blockers (OR 0.84; 95% CI 0.72 to 0.97). Patients with RE-AMI had higher hospital mortality compared with those without RE-AMI (OR 4.35; 95% CI 3.83 to 4.95). Multivariate logistic regression analysis showed an independent association of RE-AMI with in-hospital death (OR 6.60; 95% CI 5.61 to 7.70), repeat revascularization (OR 2.91; 95% CI 2.42 to 3.50), low workload capacity on the bicycle ergometry test (OR 2.17; 95% CI 1.71 to 2.76), and ejection fraction <40% (OR 1.72; 95% CI 1.38 to 2.14) at discharge. Thus, RE-AMI occurs in 4.7% of patients after an AMI. Previous AMI, age >70 years, diagnostic first electrocardiogram, and female gender are independent determinants for RE-AMI. Thrombolysis is associated with a higher and β blockers with a lower incidence of RE-AMI. Once a RE-AMI occurs, it is a strong predictor of in-hospital mortality and morbidity.
Prediction of cardiac mortality after myocardial infarction: The role of maximal treadmill stress echocardiography
2001, Journal of the American Society of Echocardiography
Patients frequently undergo low-level exercise treadmill testing after acute myocardial infarction (MI) and, in the absence of inducible ischemia, a maximal test several weeks later. This study examines 203 patients who had 2-dimensional echocardiography before and after a maximal Bruce protocol exercise treadmill test performed 4 to 6 weeks after MI. The subjects were followed for a mean of 43 months (range 1 to 77 months). Predictors of cardiac mortality by multivariate or univariate analysis included an ejection fraction ≤40%, diabetes, age >70 years, and ischemia by exercise echocardiography but not by electrocardiog raphy. Therefore, standard electrocardiographic monitoring during exercise treadmill testing 6 weeks after MI fails to predict cardiac mortality. The addition of pre-exercise and post-exercise treadmill stress echo-cardiography to readily available clinical parameters identifies those patients at greatest risk for cardiac death (resting ejection fraction ≤40%) and detects residual exercise-induced ischemia that may be of additional prognostic value.
Risk stratification after acute myocardial infarction in the reperfusion era
2000, Progress in Cardiovascular Diseases
Historically, risk stratification for survivors of acute myocardial infarction (AMI) has centered on 3 principles: assessment of left ventricular function, detection of residual myocardial ischemia, and estimation of the risk for sudden cardiac death. Although these factors still have important prognostic implications for these patients, our ability to predict adverse cardiac events has significantly improved over the last several years. Recent studies have identified powerful predictors of adverse cardiac events available from the patient history, physical examination, initial electrocardiogram, and blood testing early in the evaluation of patients with AMI. Numerous studies performed in patients receiving early reperfusion therapy with either thrombolysis or primary angioplasty have emphasized the importance of a patent infarct related artery for long-term survival. The predictive value of a variety of noninvasive and invasive tests to predict myocardial electrical instability have been under active investigation in patients receiving early reperfusion therapy. The current understanding of the clinically important predictors of clinical outcomes in survivors of AMI is reviewed in this article. Copyright © 2000 by W.B. Saunders Company
Progress in Cardiovascular Diseases, Vol. 42, No. 4 (January/February), 2000: pp 273-309
Comparison of the prognosis after early versus late recurrent nonfatal myocardial infarction
1998, American Heart Journal
Background Recurrent nonfatal myocardial infarction (RNMI) is the most significant risk factor for later outcome after an index infarction. However, little is known about the prognosis after RNMIs that occur beyond the first year after the index infarction.
Methods and Results In 3867 nonselected patients <76 years old with an acute myocardial infarction, we studied the rate of and prognosis after a first RNMI, depending on the year of its occurrence after the index infarction. Mortality rate was estimated by the method of Kaplan-Meier, and the differences were evaluated by means of the Tarone-Ware test. Four hundred ninety-three (13.6%) patients had a first RNMI in the first, 151 (5.4%) in the second, 105 (4.2%) in the third, and 71 (3.8%) in the fourth year after the index infarction (groups 1 through 4). One-year mortality rate after RNMI was 23.7% in the first group, 24.1% in the second group, 17.5% in the third group, and 22.8 in the fourth group. When all the groups were compared with each other, no significant difference was found between the mortality rates (p = 0.12) or standardized mortality rates.
Conclusions Late RNMIs have almost the same grave prognosis as do early RNMIs. (Am Heart J 1998;136:164-8.)

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^☆: This study was supported by the National Institutes of Health Research Grant HL17682, Ischemic Heart Disease Specialized Center of Research (SCOR), awarded by the National Heart, Lung and Blood Institute.

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Factors associated with recurrent myocardial infarction within one year after acute myocardial infarction☆

Abstract

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardol

Am J Cardiol

Am J Cardiol

Am J Cardiol

Int J Cardiol

J Am Coll Cardiol

Am J Cardiol

Am Heart J

Am J Cardiol

J Am Coll Cardiol

Am J Cardiol

Prog Cardiovasc Dis

Prediction of cardiovascular deaths and non-fatal reinfarctions after myocardial infarction

Acta Med Scand

Prognostic value exercise test variables after myocardial infarction

J Cardiac Rehabil

Prediction of cardiac events after uncomplicated myocardial infarction: a prospective study comparing predischarge exercise thallium-201 scintigraphy and coronary angiography

Circulation

Early exercise tests after uncomplicated acute myocardial infarction before early discharge from hospital

Acta Med Scand