BACKGROUND: Patients who develop a reinfarction are at increased risk for subsequent reinfarctions and death. However, follow-up studies in these patients are rare. OBJECTIVE: The purpose of this study was to examine the risk of mortality after a first myocardial reinfarction and to determine the independent contribution of nonfatal reinfarction to the risk of subsequent mortality. METHODS: The prognostic value of nonfatal reinfarction was assessed in a large series (n=3097) of patients with a first myocardial infarction who participated in the ASPECT trial, comparingcoumarin or matching placebo. RESULTS: A second myocardial infarction was documented in 299 patients (82% Q-wave infarctions), 45 (15%) of which were fatal. Of the 254 nonfatal reinfarctions, 31 patients (12%) died during subsequent follow-up. After adjustment for baseline characteristics, the relative risks of nonfatal reinfarction for subsequent cardiac mortality at one month were: 2.90 (1.49-5.64), at one year: 2.50 (1.47-4.23) and at three years: 2.71 (1.77-4.17). Rates of death or a second reinfarction in patients who did not undergo a revascularisation procedure after a first reinfarction were almost three times higher than in patients who did have PTCA or bypass surgery after a reinfarction (38% versus 14%; p<0.0001). CONCLUSION: This study population with three-year follow-up confirms that nonfatal reinfarction carries a strong and independent risk for recurrent reinfarction and subsequent mortality. Thus, prevention of reinfarction by intensive treatment might contribute in reduction of mortality.
RCT Entities:
BACKGROUND:Patients who develop a reinfarction are at increased risk for subsequent reinfarctions and death. However, follow-up studies in these patients are rare. OBJECTIVE: The purpose of this study was to examine the risk of mortality after a first myocardial reinfarction and to determine the independent contribution of nonfatal reinfarction to the risk of subsequent mortality. METHODS: The prognostic value of nonfatal reinfarction was assessed in a large series (n=3097) of patients with a first myocardial infarction who participated in the ASPECT trial, comparing coumarin or matching placebo. RESULTS: A second myocardial infarction was documented in 299 patients (82% Q-wave infarctions), 45 (15%) of which were fatal. Of the 254 nonfatal reinfarctions, 31 patients (12%) died during subsequent follow-up. After adjustment for baseline characteristics, the relative risks of nonfatal reinfarction for subsequent cardiac mortality at one month were: 2.90 (1.49-5.64), at one year: 2.50 (1.47-4.23) and at three years: 2.71 (1.77-4.17). Rates of death or a second reinfarction in patients who did not undergo a revascularisation procedure after a first reinfarction were almost three times higher than in patients who did have PTCA or bypass surgery after a reinfarction (38% versus 14%; p<0.0001). CONCLUSION: This study population with three-year follow-up confirms that nonfatal reinfarction carries a strong and independent risk for recurrent reinfarction and subsequent mortality. Thus, prevention of reinfarction by intensive treatment might contribute in reduction of mortality.
Authors: M L Simoons; M van den Brand; M Lincoff; R Harrington; R van der Wieken; A Vahanian; W Rutsch; J Kootstra; E Boersma; R M Califf; E Topol Journal: Eur Heart J Date: 1999-08 Impact factor: 29.983
Authors: F Bär; J Vainer; J Stevenhagen; K Neven; R Aalbregt; T O Ophuis; V van Ommen; H de Swart; E de Muinck; W Dassen; H Wellens Journal: J Am Coll Cardiol Date: 2000-07 Impact factor: 24.094
Authors: G I Barbash; A Roth; H Hod; M Modan; H I Miller; S Rath; Y H Zahav; G Keren; M Motro; A Shachar Journal: Am J Cardiol Date: 1990-09-01 Impact factor: 2.778
Authors: F Vermeer; A J Oude Ophuis; E J vd Berg; L G Brunninkhuis; C J Werter; A G Boehmer; A H Lousberg; W R Dassen; F W Bär Journal: Heart Date: 1999-10 Impact factor: 5.994
Authors: E J Topol; R M Califf; B S George; D J Kereiakes; C W Abbottsmith; R J Candela; K L Lee; B Pitt; R S Stack; W W O'Neill Journal: N Engl J Med Date: 1987-09-03 Impact factor: 91.245
Authors: W E Boden; R A O'Rourke; M H Crawford; A S Blaustein; P C Deedwania; R G Zoble; L F Wexler; R E Kleiger; C J Pepine; D R Ferry; B K Chow; P W Lavori Journal: N Engl J Med Date: 1998-06-18 Impact factor: 91.245
Authors: Alexander C Fanaroff; Vic Hasselblad; Matthew T Roe; Deepak L Bhatt; Stefan K James; Ph Gabriel Steg; C Michael Gibson; E Magnus Ohman Journal: Int J Cardiol Date: 2017-03-14 Impact factor: 4.164