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Magnitude and Characteristics of Patients Who Survived an Acute Myocardial Infarction
Mayra Tisminetzky1,2,3, Tracy Y Wang4, Jerry Gurwitz1,2,3
1Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA.
Insights
Most patients discharged after acute myocardial infarction (AMI) are low-risk survivors. Identifying these individuals helps focus interventions on higher-risk patients during the critical post-discharge period.
Area of Science:
- Cardiology
- Clinical Research
- Public Health
Background:
- Acute myocardial infarction (AMI) survivors face risks of adverse cardiovascular events post-discharge.
- Understanding patient characteristics associated with favorable outcomes is crucial for optimizing care transitions.
Purpose of the Study:
- To determine the proportion and characteristics of patients who avoid major adverse cardiovascular events early and late after hospital discharge for AMI.
- To identify factors associated with being a low-risk survivor post-AMI.
Main Methods:
- Analysis of data from 12,243 patients in the TRANSLATE-ACS study.
- Multivariable regression modeling to identify factors associated with 6-week and 1-year survival without recurrent AMI, stroke, revascularization, or unstable angina rehospitalization.
Main Results:
- 92.4% of patients were classified as early low-risk survivors (6 weeks post-discharge).
- 76.3% were classified as late low-risk survivors (1 year post-discharge).
- Male sex, single-vessel coronary artery disease, absence of chronic conditions, short hospital stay (≤3 days), and high quality-of-life scores were associated with being a low-risk survivor.
Conclusions:
- A large majority of patients discharged after AMI are low-risk survivors.
- Identifying these low-risk individuals allows for targeted resource allocation.
- Healthcare providers can focus intensive interventions on higher-risk patients during the post-discharge transition.
Background:
The purpose of this study was to describe the magnitude and characteristics of patients who did not experience any significant major adverse cardiovascular event early (within 6 weeks) and late (during the first year) after hospital discharge for an acute myocardial infarction (AMI).
Methods And Results:
Data from 12 243 patients discharged after an AMI from 233 sites across the United States in the TRANSLATE-ACS (Treatment With ADP Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome) study were analyzed. Multivariable adjusted regression analyses modeled factors associated with 6-week and 1-year survivors who did not experience a recurrent AMI, stroke, unplanned coronary revascularization, or rehospitalization for unstable angina/chest pain during these time periods. The average age of this study population was 60.0 years, 72.0% were men, and 87.9% were white. In this population, 92.4% were classified as early low-risk survivors and 76.3% were classified as late low-risk survivors of an AMI. Factors associated with being an early and late postdischarge survivor included being male and having single-vessel coronary artery disease at the patient's index hospitalization. Patients who were not first seen with any chronic health condition, had an index hospital stay of ≤3 days, and had high baseline quality-of-life scores were more likely to be late low-risk survivors.
Conclusions:
Identifying low-risk survivors of an AMI may permit healthcare providers to focus more intensive efforts and interventions on those at higher risk of experiencing adverse cardiovascular events during the postdischarge transition period.
Clinical Trial Registration:
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01088503.
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