What is the clinical evidence from this study?

Study design: Cohort. Population: Myocardial infarction (n=82108). Intervention: Recent time period (2015-2017) and guideline-recommended treatments vs. Historical time period (2000-2002). Primary outcome: 5-year mortality (p=<0.001).

November 26, 2022Open Access

Long-term mortality, cardiovascular events, and bleeding in stable patients 1 year after myocardial infarction: a Danish nationwide study

Q: What are the key findings of this study?

Treatment in the most recent period (2015-2017) compared to 2000-2002 was associated with a reduction in 5-year mortality from 18.6% to 12.5% (P-trend <0.001) for patients stable 1 year post-MI.

Key Result

Treatment in the most recent period (2015-2017) compared to 2000-2002 was associated with a reduction in 5-year mortality from 18.6% to 12.5% (P-trend <0.001) for patients stable 1 year post-MI.

Study Design

Type

Cohort (n=82,108)

Multicenter

Yes

Structured PICO

How have the long-term risks of mortality, cardiovascular events, and bleeding changed over time in stable patients 1 year after a first-time MI?

Population

82,108 patients with first-time MI during 2000-2017 who survived 1 year free from bleeding and cardiovascular events, median age 64 years, 68.2% male, in Denmark.

Intervention

Guideline-recommended treatments over consecutive 3-year periods (2000-2017)

Comparator

Earlier time periods (e.g., 2000-2002)

Outcome

5-year risks of mortality, recurrent MI, and bleedinghard clinical

Long-term risks of mortality, recurrent MI, and bleeding have significantly decreased over the past two decades in stable patients 1 year post-MI, correlating with increased use of guideline-directed therapies.

Main Result

Absolute Event Rate: 12.5% vs 18.6%

p-value: p=<0.001

Abstract

Abstract Aims Outcomes after myocardial infarction (MI) improved during recent decades alongside better risk factor management and implementation of guideline-recommended treatments. However, it is unknown whether this applies to stable patients who are event-free 1 year after MI. Methods and results Using nationwide Danish registries, we included all patients with first-time MI during 2000–17 who survived 1 year free from bleeding and cardiovascular events (n = 82 108, median age 64 years, 68.2% male). Follow-up started 1 year after MI and continued through January 2022. Crude risks of mortality, cardiovascular events, and bleeding were estimated in consecutive 3-year periods. Standardized risks were calculated with respect to the distribution of age, sex, comorbidities, and treatments in the latter period. Guideline-recommended treatment use increased during the study period: e.g. statins (68.6–92.5%) and percutaneous coronary intervention (23.9–68.2%). The crude 5-year risks of outcomes decreased (all P-trend 0.001): Mortality, 18.6% (95% confidence interval CI: 17.9–19.2) to 12.5% (CI: 11.9–13.1); Recurrent MI, 7.5% (CI: 7.1–8.0) to 5.5% (CI: 5.1–6.0); Bleeding, 3.9% (CI: 3.6–4.3) to 2.7% (CI: 2.4–3.0). Crude 5-year risk of mortality in 2015–17 was as low as 2.6% for patients aged 60 years. Use of guideline-recommended treatments was associated with improved outcomes: After standardization for changes in treatments, 5-year risk of mortality in 2000–02 was 15.5% (CI: 14.9–16.2). Conclusions For patients who were event-free 1 year after MI, the long-term risks of mortality, cardiovascular events, and bleeding decreased significantly, along with an improved use of guideline-recommended treatments between 2000 and 2017. In the most recent period, 1 year after MI, the risk of additional events was lower than previously reported.