New or recurrent myocardial infarction in patients with acute coronary syndrome was associated with a 5-fold higher risk of cardiovascular death at 6 months (6.5% vs 1.3%; HR 5.0, 95% CI 3.8-7.1).
Cohort (n=13,608)
Does the occurrence of new or recurrent MI by subtype increase the risk of cardiovascular death in patients with acute coronary syndrome?
All subtypes of MI defined by the universal classification system, including peri-PCI and stent thrombosis, are associated with a significantly increased risk of cardiovascular death at 6 months.
Hazard Ratio: 5 (95% CI 3.8–7.1)
Absolute Event Rate: 6.5% vs 1.3%
p-value: p=<0.001
BACKGROUND: The availability of more sensitive biomarkers of myonecrosis and a new classification system from the universal definition of myocardial infarction (MI) have led to evolution of the classification of MI. The prognostic implications of MI defined in the current era have not been well described. METHODS AND RESULTS: We investigated the association between new or recurrent MI by subtype according to the European Society of Cardiology/American College of Cardiology/American Heart Association/World Health Federation Task Force for the Redefinition of MI Classification System and the risk of cardiovascular death among 13 608 patients with acute coronary syndrome in the Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel-Thrombolysis in Myocardial Infarction 38 (TRITON-TIMI 38). The adjusted risk of cardiovascular death was evaluated by landmark analysis starting at the time of the MI through 180 days after the event. Patients who experienced an MI during follow-up had a higher risk of cardiovascular death at 6 months than patients without an MI (6.5% versus 1.3%, P<0.001). This higher risk was present across all subtypes of MI, including type 4a (peri-percutaneous coronary intervention, 3.2%; P<0.001) and type 4b (stent thrombosis, 15.4%; P<0.001). After adjustment for important clinical covariates, the occurrence of any MI was associated with a 5-fold higher risk of death at 6 months (95% confidence interval 3.8-7.1), with similarly increased risk across subtypes. CONCLUSIONS: MI is associated with a significantly increased risk of cardiovascular death, with a consistent relationship across all types as defined by the universal classification system. These findings underscore the clinical relevance of these events and the importance of therapies aimed at preventing MI.
Bonaca et al. (2011) conducted a cohort in Acute coronary syndrome (n=13,608). New or recurrent myocardial infarction vs. No myocardial infarction was evaluated on Cardiovascular death at 6 months (HR 5.0, 95% CI 3.8-7.1, p=<0.001). New or recurrent myocardial infarction in patients with acute coronary syndrome was associated with a 5-fold higher risk of cardiovascular death at 6 months (6.5% vs 1.3%; HR 5.0, 95% CI 3.8-7.1).