Lan Shen1, Bimal R Shah2, Aro Nam2, DaJuanicia Holmes2, Karen P Alexander2, Deepak L Bhatt3, P Michael Ho4, Eric D Peterson2, Ben He5, Matthew T Roe6. 1. Duke Clinical Research Institute, Durham, NC; Shanghai Renji Hospital, Department of Cardiology, Shanghai, China. 2. Duke Clinical Research Institute, Durham, NC. 3. Veterans Affairs Boston Healthcare System, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA. 4. Veterans Affairs Eastern Colorado Healthcare System, and University of Colorado, Denver, CO. 5. Shanghai Renji Hospital, Department of Cardiology, Shanghai, China. 6. Duke Clinical Research Institute, Durham, NC. Electronic address: matthew.roe@dm.duke.edu.
Abstract
BACKGROUND: Prior myocardial infarction (MI) is a known risk factor for long-term mortality among acute MI patients; but its prevalence and implications for the short-term outcomes of patients with a new, acute MI remain uncertain. METHODS: We studied a total of 319,152 consecutively enrolled ST-segment elevation MI (STEMI) and non-STEMI (NSTEMI) patients in the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines (01/2007-03/2012). Baseline characteristics, home and in-hospital treatments, mortality rates, and major bleeding were compared separately for STEMI and NSTEMI by prior MI status, with adjustment for mortality and major bleeding. RESULTS: Prior MI was documented in 19% of STEMI (n = 124,535) and 29% of NSTEMI (n = 194,617) patients, who were older, were more likely to have comorbidities or prior revascularization, and were more commonly taking secondary prevention medications at home. Guideline-recommended treatments in-hospital and at discharge did not differ in prior-MI STEMI patients, but invasive management was lower for prior-MI NSTEMI patients. The frequency of in-hospital mortality was higher for prior-MI STEMI (5.9% vs. 5.2%) and NSTEMI patients (4.3% vs. 3.4%). After adjustment, the excess mortality risk associated with prior MI was no longer present for STEMI (odds ratio = 1.06, 95% CI 0.97-1.15), with only modest excess risk for NSTEMI (odds ratio = 1.10, 95% CI 1.04-1.15). The risk of in-hospital major bleeding was marginally lower for prior-MI NSTEMI. CONCLUSION: More than 20% of patients with acute MI treated in contemporary practice have a history of a prior MI; despite differences in the baseline risk profile, there was little difference in the adjusted risk of in-hospital mortality by prior-MI status.
BACKGROUND: Prior myocardial infarction (MI) is a known risk factor for long-term mortality among acute MI patients; but its prevalence and implications for the short-term outcomes of patients with a new, acute MI remain uncertain. METHODS: We studied a total of 319,152 consecutively enrolled ST-segment elevation MI (STEMI) and non-STEMI (NSTEMI) patients in the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines (01/2007-03/2012). Baseline characteristics, home and in-hospital treatments, mortality rates, and major bleeding were compared separately for STEMI and NSTEMI by prior MI status, with adjustment for mortality and major bleeding. RESULTS: Prior MI was documented in 19% of STEMI (n = 124,535) and 29% of NSTEMI (n = 194,617) patients, who were older, were more likely to have comorbidities or prior revascularization, and were more commonly taking secondary prevention medications at home. Guideline-recommended treatments in-hospital and at discharge did not differ in prior-MI STEMI patients, but invasive management was lower for prior-MI NSTEMI patients. The frequency of in-hospital mortality was higher for prior-MI STEMI (5.9% vs. 5.2%) and NSTEMI patients (4.3% vs. 3.4%). After adjustment, the excess mortality risk associated with prior MI was no longer present for STEMI (odds ratio = 1.06, 95% CI 0.97-1.15), with only modest excess risk for NSTEMI (odds ratio = 1.10, 95% CI 1.04-1.15). The risk of in-hospital major bleeding was marginally lower for prior-MI NSTEMI. CONCLUSION: More than 20% of patients with acute MI treated in contemporary practice have a history of a prior MI; despite differences in the baseline risk profile, there was little difference in the adjusted risk of in-hospital mortality by prior-MI status.
Authors: Suzanne Machta; Victoria Gauthier; Jean Ferrières; Michèle Montaye; Samantha Huo Yung Kai; Stefy Gbokou; Katia Biasch; Marie Moitry; Philippe Amouyel; Jean Dallongeville; Aline Meirhaeghe Journal: PLoS One Date: 2022-02-14 Impact factor: 3.240