Temporal Trends and Outcome of Patients with Acute Coronary Syndrome and Prior Myocardial Infarction
Katia Orvin1, Alon Shechter1, Doron Zahger2
1Rabin Medical Center, Cardiology Department, The Faculty of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel.
Insights
Patients with a history of myocardial infarction (MI) admitted for acute coronary syndrome (ACS) have improved outcomes in recent years. However, they still face higher risks for cardiovascular events and mortality compared to those without prior MI.
Area of Science:
- Cardiology
- Public Health
Background:
- Patients with prior myocardial infarction (MI) represent a high-risk group for subsequent cardiovascular (CV) events.
- Advances in medical therapy and interventional cardiology have improved outcomes for acute coronary syndrome (ACS) patients over the past decade.
Purpose of the Study:
- To analyze temporal trends and outcomes of ACS patients with a history of MI.
- To compare outcomes between early (2000-2008) and late (2010-2018) periods within the Acute Coronary Syndrome Israeli Survey (ACSIS) cohort.
Main Methods:
- Retrospective analysis of 16,934 ACS patients from the ACSIS registry.
- Cohort divided into patients with and without prior MI.
- Temporal trend analysis comparing early and late periods for patients with prior MI.
Main Results:
- 31.4% of ACS patients had a prior MI.
- In the late period, patients with prior MI showed higher CV risk factors and increased utilization of revascularization and guideline-directed medical therapy.
- Recurrent MI, Major Adverse Cardiovascular Events (MACE), and 1-year mortality were significantly lower in the late period for patients with prior MI.
- Despite improvements, patients with prior MI still had higher mortality rates than those without prior MI.
Conclusions:
- Contemporary management has led to significant improvements in outcomes for ACS patients with prior MI.
- Patients with prior MI admitted for ACS remain at elevated risk for recurrent ischemic CV events and mortality.
Abstract:
Patients who have previously had a myocardial infarction (MI) are considered a high-risk group with increased risk for cardiovascular (CV) events. During the last decade, the outcome of acute coronary syndrome (ACS) patients has improved due to advances in medical therapy and interventional techniques. We aimed to examine temporal trends and outcomes of patients with prior MI admitted due to ACS from the Acute Coronary Syndrome Israeli Survey (ACSIS). Included were 16,934 ACS patients, of whom 31.4% had prior MI. For temporal trend analysis, the cohort was divided into an early period (2000-2008) and late period (2010-2018). For patients with prior MI, patients in the late period had a higher rate of CV risk factors and were treated more frequently with revascularization and guidelines-directed medical therapy. Recurrent MI (6.7% vs. 12%, p < 0.001), MACE (10.6% vs. 21%, p < 0.001) and 1-year mortality (10.7% vs. 14.6%, p < 0.001) were significantly lower in the late period. However, the mortality rate for patients with prior MI remained higher compared with patients without prior MI (10.7% vs. 6.8% p < 0.001) with an overall higher mortality rate in the STEMI group. Thus, despite significant improvement in outcome measures in the contemporary era, ACS patients with prior MI are still at increased risk for recurrent ischemic CV events and mortality.
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