Key result
In patients with first-occurrence myocardial infarction, the 8-year risk of recurrent MI originating from a nonculprit lesion (0.06) was twice as high as from a culprit lesion (0.03).
Observational (n=108,615)
Yes
Absolute Event Rate: 0.06% vs 0.03%
In patients with a first myocardial infarction, recurrent MIs are twice as likely to originate from previously untreated nonculprit lesions compared to previously treated culprit lesions.
Recurrent MI may arise more from nonculprit lesions; leaves open whether targeted therapies alter this pattern in observational data.
BackgroundLong-term disease progression after myocardial infarction (MI) is inadequately understood. We evaluated the pattern and angiographic properties (culprit lesion [CL]/non-CL [NCL]) of recurrent MI (re-MI) in a large real-world patient population. Methods and ResultsOur observational study used prospectively collected data in 108 615 patients with first-occurrence MI enrolled in the SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) between July 1, 2006 and November 29, 2014. During follow-up (median, 3.2 years), recurrent hospitalization for MI occurred in 11 117 patients (10.2%). Of the patients who underwent coronary angiography for the index MI, a CL was identified in 44 332 patients. Of those patients, 3464 experienced an re-MI; the infarct originated from the NCL in 1243 patients and from the CL in 655 patients. In total, 1566 re-MIs were indeterminate events and could not be classified as NCL or CL re-MIs. The risk of re-MI within 8 years related to the NCL was 0.06 (95% confidence interval [CI], 0.05-0.06), compared with 0.03 (95% CI, 0.02-0.03) for the CL. There were no large differences in baseline characteristics of patients with subsequent NCL versus CL re-MIs. Independent predictors of NCL versus CL re- MI were multivessel disease (odds ratio, 2.29; 95% CI, 1.87-2.82), male sex (odds ratio, 1.36; 95% CI, 1.09-1.71), and a prolonged time between the index and re-MI (odds ratio, 1.16; 95% CI, 1.10-1.22). ConclusionsIn a large cohort of patients with first-occurrence MI undergoing percutaneous coronary intervention, the risk of re-MI originating from a previously untreated lesion was twice higher than the risk of lesions originating from a previously stented lesion. Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT03099395.
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Varenhorst et al. (2018) conducted an observational in First-occurrence myocardial infarction (n=108,615). Nonculprit lesion vs. Culprit lesion was evaluated on Risk of recurrent myocardial infarction within 8 years. In patients with first-occurrence myocardial infarction, the 8-year risk of recurrent MI originating from a nonculprit lesion (0.06) was twice as high as from a culprit lesion (0.03).
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