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Long term health outcomes in patients with a history of myocardial infarction: A population based cohort study
Navdeep Tangri1,2, Thomas W Ferguson1,2, Reid H Whitlock1,2
1Department of Medicine, University of Manitoba, Winnipeg, MB, Canada.
Insights
Patients surviving the first year after myocardial infarction (MI) remain at high risk for major adverse cardiovascular events (MACE). Continued monitoring and treatment beyond 12 months are crucial for post-MI patients.
Area of Science:
- Cardiology
- Public Health
Background:
- Myocardial infarction (MI) poses significant long-term mortality risks.
- Optimal duration for post-MI interventions like dual antiplatelet therapy is unknown.
Purpose of the Study:
- To evaluate the long-term risk of major adverse cardiovascular events (MACE) after the first year post-MI.
- To identify factors influencing prognosis in patients after myocardial infarction.
Main Methods:
- Retrospective cohort study of 8,493 MI patients in Manitoba, Canada (2006-2010).
- Survival analysis and Cox proportional hazards models were used for outcome assessment until Nov 2014.
Main Results:
- 79.5% survived the first year post-MI without recurrent events.
- In the second year, 5.5% died, 3.6% had recurrent MI, and 1.1% had stroke.
- Older age, male sex, diabetes, prior cardiovascular events, and lack of revascularization predicted worse outcomes.
Conclusions:
- Elevated risk of MACE persists beyond the first year after myocardial infarction.
- Intensified monitoring and treatment strategies are recommended for post-MI patients after the initial year.
Background:
Myocardial infarction (MI) is associated with high morbidity and mortality, particularly in the first 12 months post-event. Interventions such as dual antiplatelet therapy can reduce the risk of major adverse cardiovascular events (MACE), but the duration of the high-risk time interval and the optimal prescription time frame for these interventions remains unknown.
Design, Setting, Participants, And Measurements:
We performed a retrospective cohort study using data from medical services and hospitalizations in Manitoba, Canada for patients admitted with a MI between April 2006 and March 2010, and followed until Nov 30, 2014. We used survival analysis to determine the cumulative incidence of death, subsequent MI, or stroke, and used Cox proportional hazards models to assess factors associated with these endpoints.
Results:
There were 8,493 patients in Manitoba admitted to hospital for a MI during the study period. Of those, 6,749 (79.5%) survived for at least 1 year without a recurrent MI or stroke. In the following year, this population remained at high risk, with 372 (5.5%) of the remaining patients dying in the next twelve months (48.1% cardiovascular deaths), 244 (3.6%) having a recurrent MI, and 74 (1.1%) having a stroke. Older age, male sex, diabetes, prior stroke, prior heart failure, prior unstable angina, and absence of revascularization were associated with worse long-term prognosis.
Conclusions:
The risk of MACE remains elevated among post-MI patients after the first year. Interventions to more intensively monitor, evaluate, and treat these patients should be considered beyond the first year following myocardial infarction.
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