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When More Means Less: The Prognosis of Recurrent Acute Myocardial Infarctions
Ygal Plakht1,2, Harel Gilutz3, Arthur Shiyovich4,5
1Department of Nursing, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel.
Abstract:
Recurrent acute myocardial infarctions (AMI) are common and associated with dismal outcomes. We evaluated the clinical characteristics and the prognosis of AMI survivors according to the number of recurrent AMIs (ReAMI) and the time interval of events (TI). A retrospective analysis of patients who survived following hospitalization with an AMI throughout 2002-2017 was conducted. The number of ReAMIs for each patient during the study period was recorded and classified based on following: 0 (no ReAMIs), 1, 2, ≥3. Primary outcome: all-cause mortality up to 10 years post-discharge from the last AMI. A total of 12,297 patients (15,697 AMI admissions) were analyzed (age: 66.1 ± 14.1 years, 68% males). The mean number of AMIs per patient was 1.28 ± 0.7; the rates of 0, 1, 2, ≥3 ReAMIs were 81%, 13.4%, 3.6% and 1.9%, respectively. The risk of mortality increased in patients with greater number of AMIs, HR = 1.666 (95% CI: 1.603-1.720, p < 0.001) for each additional event (study group), attenuated following adjustment for potential confounders, AdjHR = 1.135 (95% CI: 1.091-1.181, p < 0.001). Increased risk of mortality was found with short TI (<6-months), AdjHR = 2.205 (95% CI: 1.418-3.429, p < 0.001). The risk of mortality following AMI increased as the number of ReAMIs increased, and the TI between the events shortened. These findings should guide improved surveillance and management of this high-risk group of patients (i.e., ReAMI).
Insights
Recurrent acute myocardial infarctions (AMI) significantly increase mortality risk. Shorter time intervals between recurrent AMIs further elevate this danger, necessitating improved patient surveillance and management strategies.
Area of Science:
- Cardiology
- Clinical Medicine
- Public Health
Background:
- Recurrent acute myocardial infarctions (ReAMI) are a significant clinical challenge with poor patient outcomes.
- Understanding the impact of ReAMI frequency and timing is crucial for risk stratification.
Purpose of the Study:
- To evaluate the clinical characteristics of AMI survivors.
- To determine the prognostic impact of the number of recurrent AMIs (ReAMI) and the time interval (TI) between events on long-term mortality.
Main Methods:
- Retrospective analysis of 12,297 patients hospitalized with AMI between 2002-2017.
- Patients were categorized by the number of ReAMIs (0, 1, 2, ≥3) and TI between events.
- Primary outcome was all-cause mortality up to 10 years post-discharge.
Main Results:
- The risk of all-cause mortality increased with a higher number of ReAMIs (AdjHR=1.135 per additional event).
- A short TI (<6 months) between AMIs significantly increased mortality risk (AdjHR=2.205).
- 81% of patients experienced no ReAMI, while 19% had one or more recurrent events.
Conclusions:
- Both the number of recurrent AMIs and the time interval between events are independent predictors of mortality in AMI survivors.
- These findings highlight the need for enhanced surveillance and tailored management for high-risk patients experiencing ReAMI.
- Identifying and managing patients with frequent or closely spaced ReAMIs is critical for improving long-term survival.
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