Key result
Multiple post-AMI adverse events linked to ~485% higher long-term mortality risk versus single events.
Why the study?
Adverse events after acute myocardial infarction are individually linked to poor outcomes, but the prognostic impact of sequential, overlapping different event types within the same patient remains uncertain.
Does the occurrence of multiple adverse events compared to single events increase long-term mortality in patients following acute myocardial infarction?
Does the occurrence of multiple adverse events compared to single events increase long-term mortality in patients following acute myocardial infarction?
Experiencing multiple different adverse events (MI, stroke, bleeding) after an initial AMI drastically increases mortality risk, particularly within the first 30 days, highlighting the need for intensive early surveillance.
Answers are grounded in this paper and cite their sources.
Multiple post-AMI adverse events markedly elevate long-term mortality risk; observational data leave open whether targeted prevention improves outcomes.
Background Adverse events after acute myocardial infarction (AMI) are individually associated with poor outcomes, but the prognostic impact of the overlap of different event types occurring sequentially within the same patient remains uncertain. Aims Mortality associated with multiple events—defined as ≥ 2 different event types among spontaneous myocardial infarction (MI), ischemic stroke, and major bleeding—was compared with single events after AMI. Methods We analyzed 10,719 AMI patients in the multicenter Korean AMI registry. Patients contributed person‐time to mutually exclusive, time‐varying states: no event; MI only; stroke only; Bleeding Academic Research Consortium (BARC) type 3 bleeding only; and multiple events (≥ 2 different types). Mortality was modeled using multivariable Cox regression with stabilized inverse‐probability weighting (IPW) and piecewise intervals for early (≤ 30 days), intermediate (30 days to 1 year), and late (>1 year) risk. Results Over a median 4.9 years, 2625 patients died. Multiple events occurred in 108 patients (1.0%): MI + bleeding (55%), stroke+bleeding (31%), and MI + stroke (15%). Mortality patterns were consistent across multiple‐event combinations. Multiple events conferred the highest risk of death (5‐year IPW‐adjusted hazard ratio [HR]: 5.85, 95% confidence interval [CI]: 3.48–9.85), exceeding MI only (HR: 3.78), stroke only (HR: 2.72), or bleeding only (HR: 3.08). Mortality was most pronounced within 30 days, most markedly after multiple events (IPW‐adjusted HR: 24.0, 95% CI: 12.9–44.7). Conclusions Multiple adverse events after AMI confer substantially higher mortality risk than single events, with the greatest impact in the first 30 days. These findings support the need for an immediate and tailored approach and sustained surveillance to prevent further ischemic or bleeding complications.
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Roh et al. (2026) studied this question. Multiple adverse events after AMI increased 5-year mortality risk over 5-fold (HR 5.85), especially within 30 days (HR 24.0), compared to single events.
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