The Prognostic Impact of Multiple Adverse Events on Long-Term Mortality Following Acute Myocardial Infarction

Area of Science:

• Cardiology
• Clinical Outcomes Research
• Patient Safety

Background:

• Adverse events post-acute myocardial infarction (AMI) are linked to poor outcomes.
• The combined prognostic impact of sequential, different adverse events after AMI is not well understood.

Purpose of the Study:

• To compare mortality risks associated with multiple adverse events versus single events following AMI.
• To define multiple events as two or more distinct types: spontaneous myocardial infarction (MI), ischemic stroke, or major bleeding (BARC type 3).

Main Methods:

• Analysis of 10,719 patients from the Korean AMI registry.
• Utilized time-varying states (no event, single event types, multiple events) and multivariable Cox regression with stabilized inverse-probability weighting (IPW).
• Assessed mortality risk across early (≤30 days), intermediate (30 days-1 year), and late (>1 year) periods.

Main Results:

• Over 4.9 years, 2625 deaths occurred. Multiple events (1.0% of patients) included MI+bleeding (55%), stroke+bleeding (31%), and MI+stroke (15%).
• Multiple events conferred the highest 5-year mortality risk (IPW-adjusted HR: 5.85), exceeding single events (MI: 3.78, stroke: 2.72, bleeding: 3.08).
• The highest mortality impact was observed within 30 days post-AMI (IPW-adjusted HR for multiple events: 24.0).

Conclusions:

• Multiple adverse events after AMI substantially elevate mortality risk compared to single events.
• The greatest increase in mortality risk from multiple events occurs within the initial 30 days.
• Immediate, tailored interventions and sustained surveillance are crucial to prevent subsequent ischemic or bleeding events.