Secondary prevention strategies after an acute ST-segment elevation myocardial infarction in the AMI code era: beyond
Núria Ribas1,2,3, Cosme García-García4,5, Oona Meroño4,6
1Cardiology Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain. 60055@hospitaldelmar.cat.
Insights
The AMI code improves reperfusion therapy access for ST-segment elevation myocardial infarction (STEMI) patients. However, suboptimal control of cardiovascular risk factors like blood pressure and cholesterol limits long-term benefits, necessitating improved secondary prevention.
Area of Science:
- Cardiology
- Public Health
- Clinical Research
Background:
- The Acute Myocardial Infarction (AMI) code facilitates rapid reperfusion therapy, prioritizing primary angioplasty for ST-segment elevation myocardial infarction (STEMI) patients.
- This study evaluated the long-term management of cardiovascular risk factors in STEMI patients enrolled in the AMI code registry.
Purpose of the Study:
- To assess the effectiveness of the AMI code in ensuring long-term control of cardiovascular risk factors post-STEMI.
- To identify factors associated with mortality and cardiovascular readmissions in STEMI survivors.
Main Methods:
- Prospective inclusion of 454 STEMI patients between June 2009 and April 2013.
- Assessment of cardiovascular risk factors, morbidity, and mortality at 6-month follow-up among survivors.
- Median follow-up of 20 months for mortality and readmission rates.
Main Results:
- 87% of 6-month survivors received reperfusion therapy, predominantly primary angioplasty (98%).
- Suboptimal control was observed for blood pressure (62%), LDL-cholesterol (<29%), smoking cessation (60%), and glycemic control in diabetics (36%).
- Cumulative mortality was 6.1% and cardiovascular readmissions were 9.9% among 6-month survivors; inadequate LDL/HDL assessment correlated with higher adverse events.
Conclusions:
- While the AMI code ensures rapid reperfusion, its long-term benefits are potentially undermined by inadequate control of cardiovascular risk factors.
- Enhanced secondary prevention strategies are crucial to improve long-term outcomes for STEMI patients.
Background:
The AMI code is a regional network enhancing a rapid and widespread access to reperfusion therapy (giving priority to primary angioplasty) in patients with acute ST-segment elevation myocardial infarction (STEMI). We aimed to assess the long-term control of conventional cardiovascular risk factors after a STEMI among patients included in the AMI code registry.
Design And Methods:
Four hundred and fifty-four patients were prospectively included between June-2009 and April-2013. Clinical characteristics were collected at baseline. The long-term control of cardiovascular risk factors and cardiovascular morbidity/mortality was assessed among the 6-months survivors.
Results:
A total of 423 patients overcame the first 6 months after the STEMI episode, of whom 370 (87%) underwent reperfusion therapy (363, 98% of them, with primary angioplasty). At 1-year follow-up, only 263 (62%) had adequate blood pressure control, 123 (29%) had LDL-cholesterol within targeted levels, 126/210 (60%) smokers had withdrawn from their habit and 40/112 (36%) diabetic patients had adequate glycosylated hemoglobin levels. During a median follow-up of 20 (11-30) months, cumulative mortality of 6 month-survivors was 6.1%, with 9.9% of hospital cardiovascular readmissions. The lack of assessment of LDL and HDL-cholesterol were significantly associated with higher mortality and cardiovascular readmission rates.
Conclusions:
Whereas implementation of the AMI code resulted in a widespread access to rapid reperfusion therapy, its long-term therapeutic benefit may be partially counterbalanced by a manifestly suboptimal control of cardiovascular risk factors. Further efforts should be devoted to secondary prevention strategies after STEMI.
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