Comparison of Outcome of Recurrent Versus First ST-Segment Elevation Myocardial Infarction (from National Israel Surveys 1998 to 2006)

doi:10.1016/j.amjcard.2011.02.332

The American Journal of Cardiology

Volume 107, Issue 12, 15 June 2011, Pages 1730-1737

https://doi.org/10.1016/j.amjcard.2011.02.332 Get rights and content

Patients with recurrent acute myocardial infarction (AMI), who represent ≤35% of hospitalized patients with AMI, are at an increased risk of complications and death. Our study purpose was to compare the treatment and outcome of patients hospitalized with recurrent acute ST-segment elevation myocardial infarction (STEMI) from 1998 to 2006 with those of patients with a first STEMI. We performed 5 biennial nationwide 2-month surveys during 1998 to 2006, collecting data prospectively from all patients hospitalized for AMI or acute coronary syndrome in all 25 coronary care units in Israel. The present cohort included 4,543 patients with STEMI, 3,679 (76%) with first and 864 (24%) with recurrent STEMI. The patients with recurrent STEMI were older (66 ± 13 vs 62 ± 13 years), had greater rates of diabetes, hypertension, and previous angina, had a worse Killip class on admission, and experienced more in-hospital complications. The all-cause hospital crude mortality rate was 8.1% in patients with recurrent STEMI versus 5.5% in those with a first STEMI (adjusted odds ratio 1.71 95% confidence interval 1.19 to 2.44), and the 1-year mortality rate was 18.9% versus 10.9%, respectively (hazard ratio 1.85, 95% confidence interval 1.41 to 2.43). From 1998 to 2006, an insignificant trend toward a 1-year mortality reduction among patients with recurrent STEMI was seen and those with a first STEMI had a significant mortality decrease. In conclusion, patients admitted for recurrent STEMI have worse in-hospital and 1-year outcomes that did not improve during the study period. An improved therapeutic approach is needed for these high-risk patients.

Section snippets

Methods

Five biennial, prospective, nationwide, 2-month surveys were conducted in all 25 operating CCUs in Israel, collecting data prospectively for all patients with AMI/ACS hospitalized during January to February 1998, February to March 2000, February to March 2002, February to March 2004, and March to April 2006. The details of these surveys, called Acute Coronary Syndrome Israeli Survey (ACSIS), have been previously described.¹⁶

Data on patient characteristics, in-hospital course, and management

Results

During the survey period, 7,097 patients with AMI (STEMI and non-STEMI) were hospitalized. Of the 7.097 patients, 5,394 (76%) had a first AMI and 1,703 (24%) a recurrent AMI. The first AMI population included 3,679 patients (68%) with STEMI and the recurrent AMI group included only 864 patients (51%) with STEMI. The patients with STEMI constituted the present study population. The percentage of admissions for STEMI of the total AMI admissions decreased significantly in both groups during the

Discussion

Numerous publications have reported on the decreasing incidence and improved survival rates of patients admitted with an ACS event, in general, and of patients with STEMI, in particular.13, 16, 17 However, only few reports have targeted recurrent AMI, and practically none have specifically evaluated the recurrent STEMI population, which is a higher risk subgroup of those with AMI. The present analysis of the community-based observational prospective surveys of consecutive patients with ACS

References (22)

A. Shotan et al.
Prognosis of patients with acute myocardial infarction before and in the reperfusion era—a national study
Am Heart J
(2001)
F.G. Kushner et al.
Focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update) a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
J Am Coll Cardiol
(2009)
Randomized trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarctionISIS-2
Lancet
(1988)
Effectiveness of intravenous thrombolytic treatment in acute myocardial infarctionGruppo Italiano per lo Studio della Streptochinasi Nell'Infarto Miocardico (GISSI)
Lancet
(1986)
A randomized factorial trial assessing early oral captopril, oral mononitrate, and intravenous magnesium sulphate in 58,050 patients with suspected acute myocardial infarction
Lancet
(1995)
effects of lisinopril and transdermal glyceryl trinitrate singly and together on 6-week mortality and ventricular function after acute myocardial infarction
Lancet
(1994)
Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients
Lancet
(1994)
M. Janion et al.
Clinical course and long-term prognosis in patients with recurrent myocardial infarction
Pol Arch Med Wewn
(2000)
A.A. Motivala et al.
A prior myocardial infarction: how does it affect management and outcomes in recurrent acute coronary syndromes?
Clin Cardiol
(2008)
D. Lloyd-Jones et al.
Heart disease and stroke statistics—2010 update: a report from the American Heart Association
Circulation
(2009)

K.A.A. Fox et al.

Decline in rates of death and heart failure in acute coronary syndromes, 1999–2006

JAMA

(2007)

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Recurrent ST-elevation myocardial infarctions (STEMIs) are associated with poorer prognosis. A diminished haematopoietic response has been proposed as the mechanism responsible for this, but has yet to be validated in human studies. We therefore aim to map out the leukocyte response, and its subtypes, following the first and second STEMI to identify if the inflammatory response is dampened after recurrent myocardial infarctions.
Retrospective cohort study of patients presenting with recurrent STEMI undergoing percutaneous coronary intervention. Full blood counts were taken within 24 h of each admission, and daily thereafter. The primary outcome was whether there were any qualitative or quantitative difference in leukocyte cell response (and its subtypes) between first and second STEMI.
Thirty-one patients (mean age 59 years [SD 14.9], 26 males [83.9%]) with an average of 3.1 years between infarcts were included in the study. Overall, between first and second STEMI, similar mean leukocyte response (and its subtypes) was observed from admission to day three post PCI. Similarly, the peak leukocyte response (and its subtypes) was similar between the two STEMIs, even after adjusting for infarct size.
In recurrent STEMIs, there is no long-term memory effect on the cellular inflammatory response leading to diminished peripherally circulating leucocytes, and its subtypes.
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Adherence to guideline-recommended, long-term secondary preventative therapies among patients with acute coronary syndrome (ACS) is fundamental to improving long-term outcomes. The purpose of this scoping review was to provide a broad synopsis of pertinent studies in a structured and comprehensive way regarding factors that influence patient adherence to medical therapy after ACS.
Relevant articles focusing on adherence to medical therapy after ACS were retrieved from the EMBASE and MEDLINE databases (search date, September 7, 2021). Studies were independently screened, and relevant information was extracted.
A total of 58 studies were identified by using the EMBASE and MEDLINE databases. Adherence to secondary prevention was moderate to low and steadily decreased over time. Nearly 30% of patients discontinued one or more medications within 90 days of their primary ACS, and adherence decreased to 50% to 60% at 1 year postdischarge. There were no major differences in adherence between drug classes. Factors influencing patient adherence can be broadly divided into 3 categories: patient related, health care system related, and disease related. Patients managed with percutaneous coronary interventions were more adherent to follow-up treatment than medically managed patients. Depression was reported as a major psychological factor that negatively affected adherence. Improved adherence was observed when higher levels of patient education and provider engagement were delivered during postdischarge follow-up, particularly when scheduled early. Notably, the incidence of major adverse cardiovascular events was lower in hospitals with high 90-day medication adherence than those with moderate or low adherence.
Patient nonadherence to guideline-recommended long-term pharmacologic secondary preventative therapies after ACS is multifactorial. A comprehensive multifaceted approach should be implemented to improve adherence and clinical outcomes. This approach should include key interventions such as early follow-up visits, high medication adherence at 90 days, patient engagement and education, and development of novel interventions that support the 3 broad categories influencing patient adherence as discussed in this review.
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The objectives of the study were to characterize the long-term risk of first recurrence of acute coronary syndrome (ACS) among survivors of an incident ACS, as a function of the STEMI/NSTEMI/UA diagnosis.
Men and women (aged 35–74) hospitalized between 2009 and 2016 for an incident ACS in the French MONICA registries and still alive on discharge were followed-up until December 2017. Recurrent events were defined as the first (non-fatal or fatal) ACS occurring after hospital discharge from the incident event.
The study comprised 15,739 incident ACSs with 63,777 patient-years of follow-up. The cumulative probability [95% confidence interval] of recurrent ACS was 6.7% [6.3–7.1%] at 1 year and 18.4% [17.4–19.5%] at 9 years. The cumulative probability of fatal recurrent ACS was 1.4% [1.2–1.5%] at 1 year and 4.3% [3.6–4.9%] at 9 years. The risk of recurrence did not depend on the type of the incident ACS after adjustment for confounding factors. The most frequent forms of recurrence were NSTEMI and UA. The presence of a major complication (OR = 1.59) and an impaired left ventricular ejection fraction (LVEF) (OR > 1.26) increased the risk of recurrence. The annual 1-year recurrence rates decreased from 7.4% in 2009 to 4.0% in 2016 (p < 0.001).
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Citation Excerpt :
Moreover, few studies have explored whether the acute effects of PM2.5 differed across strata defined by AMI etiology (ST-elevation myocardial infarction: STEMI vs. non ST-elevation myocardial infarction: NSTEMI). Recurrent AMI is associated with higher risk of complications, lower survival, and poorer quality of life relative to the initial AMI (Shotan et al., 2011). Despite best efforts at secondary prevention, the incidence rate of recurrent AMI remains high, accounting for ∼20% of hospitalized patients with AMI (Mozaffarian et al., 2016).
Monitoring data on fine particulate matter (PM_2.5) level in China's major cities were available since 2013. We conducted a time-stratified case-crossover study to evaluate the association between short-term exposure to PM_2.5 and hospital admissions for acute myocardial infarction (AMI), as well as subsequent cardiac and AMI readmissions among AMI survivors. Hospital admissions for ST-elevation myocardial infarction (STEMI) and non ST-elevation myocardial infarction (NSTEMI) from 1 January 2014 through 31 December 2015 were identified from electronic Hospitalization Summary Reports. Conditional logistic regression was used to explore the relation between PM_2.5 and hospital admissions for AMI. Individuals discharged alive following STEMI in 2014 were followed up for subsequent readmissions through 31 December 2015. We used the Cox proportional hazards model to evaluate the effect of PM_2.5 pollution on subsequent cardiac and STEMI readmissions. Hospital admissions for STEMI (n = 106,467) and NSTEMI (n = 12,719) were examined separately. Exposure to an interquartile range (IQR) increase in PM_2.5 concentration (47.5 μg/m³) at lags 2, 3, 4 and 0–5 days corresponded with 0.6% (95% CI, 0.1%–1.1%), 0.8 (95% CI, 0.3%–1.3%), 0.6% (95% CI, 0.1%–1.1%) and 0.9% (95% CI, 0–1.8%) increases in STEMI admissions, respectively. For NSTEMI, no significant association was observed with PM_2.5. We also observed significant associations of PM_2.5 concentration with both subsequent cardiac and STEMI readmissions among STEMI survivors. In conclusion, short-term elevations in PM_2.5 concentration may increase the risk of STEMI but not NSTEMI, and the association appeared to be more evident among STEMI survivors.
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Coronary artery diseaseComparison of Outcome of Recurrent Versus First ST-Segment Elevation Myocardial Infarction (from National Israel Surveys 1998 to 2006)

Section snippets

Methods

Results

Discussion

Am Heart J

J Am Coll Cardiol

Randomized trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarctionISIS-2

Lancet

Effectiveness of intravenous thrombolytic treatment in acute myocardial infarctionGruppo Italiano per lo Studio della Streptochinasi Nell'Infarto Miocardico (GISSI)

Lancet

A randomized factorial trial assessing early oral captopril, oral mononitrate, and intravenous magnesium sulphate in 58,050 patients with suspected acute myocardial infarction

Lancet

effects of lisinopril and transdermal glyceryl trinitrate singly and together on 6-week mortality and ventricular function after acute myocardial infarction

Lancet

Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients

Lancet

Clinical course and long-term prognosis in patients with recurrent myocardial infarction

Pol Arch Med Wewn

A prior myocardial infarction: how does it affect management and outcomes in recurrent acute coronary syndromes?

Clin Cardiol

Heart disease and stroke statistics—2010 update: a report from the American Heart Association

Circulation

Decline in rates of death and heart failure in acute coronary syndromes, 1999–2006

JAMA

Coronary artery disease
Comparison of Outcome of Recurrent Versus First ST-Segment Elevation Myocardial Infarction (from National Israel Surveys 1998 to 2006)