Furio Colivicchi1, Stefania Angela Di Fusco1, Michele Massimo Gulizia2,3, Leonardo De Luca4, Giovanna Geraci5, Federico Nardi6, Roberta Rossini7, Lucio Gonzini8, Pietro Scicchitano9, Pasquale Caldarola10, Andrea Di Lenarda11, Domenico Gabrielli12. 1. Clinical and Rehabilitative Cardiology Unit, San Filippo Neri Hospital ASL Roma1, Rome. 2. Cardiology Division, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione 'Garibaldi' Catania. 3. Presidente Fondazione per il Tuo cuore; Heart Care Foundation, Florence, Italy. 4. Division of Cardiology, A.O. San Camillo-Forlanini, Rome. 5. U.O. Cardiologia, A.O.R. Villa Sofia-Cervello, P.O. Cervello, Palermo. 6. Division of Cardiology, Santo Spirito Hospital, Casale Monferrato (AL), Italy. 7. Division of Cardiology, S. Croce e Carle Hospital, Cuneo. 8. ANMCO Research Center, Fondazione per il Tuo cuore - HCF onlus, Florence. 9. Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, School of Medicine, University of Bari. 10. U.O.C. Cardiologia-UTIC, San Paolo Hospital, Bari. 11. Cardiovascular Center, University Hospital and Health Services of Trieste. 12. Division of Cardiology, Augusto Murri Hospital, Fermo, Italy.
Abstract
AIMS: Clinical management of patients more than 1 year after acute myocardial infarction (MI) is challenging. Patient risk stratification may help to establish therapeutic priorities. We aimed to describe the comprehensive risk profile and management of patients with prior MI. METHODS: We analyzed data from the EYESHOT Post-MI study, which evaluated the management of patients 1-3 years after MI. The risk profile of participants was defined according to the qualifying high-risk features of the PEGASUS-TIMI 54 trial (history of diabetes, history of recurrent MI, angiographic evidence of multivessel coronary disease, chronic kidney disease with estimated glomerular filtration rate <60 ml/min, age ≥65 years). Patients were classified into five subgroups according to the presence of zero, one, two, three, or more than three features. RESULTS: Of the 1633 patients in the EYESHOT Post-MI study, 1008 could be stratified according to PEGASUS-TIMI 54 high-risk features. About 22% of patients had no high-risk features, whereas 25% showed at least three features. The prevalence of patients with specific clinical severity indicators was progressively higher with the increasing number of high-risk features. Dual antiplatelet therapy and oral anticoagulation were more frequently used in patients with an increasing number of high-risk features (P for trend <0.0001). Lipid-lowering therapies were less frequently prescribed in patients with a higher number of features (P for trend 0.006 for statins; P for trend 0.007 for ezetimibe). CONCLUSION: Higher-risk post-MI patients, identified by PEGASUS-TIMI 54 high-risk features, showed an increased prevalence of major clinical severity indicators. Secondary prevention therapies were not adequately implemented in higher-risk patients.
AIMS: Clinical management of patients more than 1 year after acute myocardial infarction (MI) is challenging. Patient risk stratification may help to establish therapeutic priorities. We aimed to describe the comprehensive risk profile and management of patients with prior MI. METHODS: We analyzed data from the EYESHOT Post-MI study, which evaluated the management of patients 1-3 years after MI. The risk profile of participants was defined according to the qualifying high-risk features of the PEGASUS-TIMI 54 trial (history of diabetes, history of recurrent MI, angiographic evidence of multivessel coronary disease, chronic kidney disease with estimated glomerular filtration rate <60 ml/min, age ≥65 years). Patients were classified into five subgroups according to the presence of zero, one, two, three, or more than three features. RESULTS: Of the 1633 patients in the EYESHOT Post-MI study, 1008 could be stratified according to PEGASUS-TIMI 54 high-risk features. About 22% of patients had no high-risk features, whereas 25% showed at least three features. The prevalence of patients with specific clinical severity indicators was progressively higher with the increasing number of high-risk features. Dual antiplatelet therapy and oral anticoagulation were more frequently used in patients with an increasing number of high-risk features (P for trend <0.0001). Lipid-lowering therapies were less frequently prescribed in patients with a higher number of features (P for trend 0.006 for statins; P for trend 0.007 for ezetimibe). CONCLUSION: Higher-risk post-MI patients, identified by PEGASUS-TIMI 54 high-risk features, showed an increased prevalence of major clinical severity indicators. Secondary prevention therapies were not adequately implemented in higher-risk patients.