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Published on: April 25, 2014
Prognostic significance of nonfatal myocardial reinfarction. Multicenter Diltiazem Postinfarction Trial Research
J Benhorin1, A J Moss, D Oakes
1Division of Biostatistics, University of Rochester School of Medicine and Dentistry, New York 14642.
Insights
Nonfatal reinfarction significantly increases cardiac death risk after myocardial infarction. This independent risk is substantial, especially for first-time heart attack patients, highlighting its importance in post-MI care.
Area of Science:
- Cardiology
- Clinical Trials
- Outcomes Research
Background:
- Cardiac mortality and nonfatal reinfarction are key endpoints in post-myocardial infarction (MI) trials.
- The independent prognostic value of nonfatal reinfarction for subsequent cardiac death remains incompletely quantified.
Purpose of the Study:
- To determine the prognostic significance of nonfatal reinfarction in patients surviving acute myocardial infarction.
Main Methods:
- Analysis of a multicenter diltiazem trial database including 1,234 patients treated with placebo.
- Follow-up duration of 1 to 4 years post-acute myocardial infarction.
- Cox survivorship analyses using nonfatal reinfarction as a time-dependent predictor variable.
Main Results:
- Nonfatal reinfarction occurred in 116 patients (9.4%), with 12% experiencing subsequent cardiac death.
- Patients with nonfatal reinfarction had a significantly higher risk of cardiac death (hazard ratio 3.0, p = 0.002) compared to event-free patients.
- This risk was independent of other clinical variables and was amplified in patients whose index event was their first infarction (hazard ratio 5.4, p = 0.0006).
Conclusions:
- Nonfatal reinfarction represents a strong, independent predictor of subsequent cardiac mortality in post-myocardial infarction patients.
- The prognostic impact of nonfatal reinfarction is significant and warrants consideration in risk stratification and management strategies.
- Identifying patients with nonfatal reinfarction is crucial for optimizing secondary prevention and improving long-term outcomes after acute myocardial infarction.
Abstract:
In most risk stratification and intervention postinfarction trials, cardiac mortality is used as the major outcome end point either alone or in combination with nonfatal reinfarction. However, the independent risk carried by nonfatal reinfarction for subsequent cardiac death has not been quantified. The prognostic significance of nonfatal reinfarction was determined from the multicenter diltiazem trial data base of 1,234 patients treated with placebo followed up for 1 to 4 years after acute myocardial infarction. One hundred sixteen patients had at least one nonfatal reinfarction, 14 (12%) of whom subsequently experienced cardiac death. Of the remaining 1,118 patients without nonfatal reinfarction, 110 (9.8%) experienced cardiac death. Compared with event-free patients, patients with nonfatal reinfarction were more likely (p less than 0.05) to be women, to have had an infarction before their index event and to have had prior cardiac-related symptoms. Cox survivorship analyses, using pertinent baseline clinical variables along with nonfatal reinfarction as a time-dependent predictor variable, revealed that nonfatal reinfarction carried a significant and independent risk for subsequent cardiac mortality (hazard ratio 3.0, p = 0.002), which was greater than that carried by other significant predictor variables (New York Heart Association functional class, pulmonary congestion on chest radiograph, blood urea nitrogen level, predischarge Holter-recorded ventricular premature complexes and radionuclide ejection fraction). The cardiac mortality risk associated with nonfatal reinfarction was further increased in patients whose index event was their first infarction (hazard ratio 5.4, p = 0.0006). Thus, nonfatal reinfarction carries a strong, significant and independent risk for subsequent cardiac death in patients surviving an acute myocardial infarction.
