Key result
Event-free one-year post-MI survivors face high residual risk with ~6% mortality in the following year.
Cohort (n=8,493)
The risk of major adverse cardiovascular events remains substantially elevated beyond the first year post-myocardial infarction, suggesting a need for continued intensive secondary prevention.
High residual risk persists beyond one year post-MI; hypothesis-generating for extended secondary prevention but should not yet change practice.
BACKGROUND: Myocardial infarction (MI) is associated with high morbidity and mortality, particularly in the first 12 months post-event. Interventions such as dual antiplatelet therapy can reduce the risk of major adverse cardiovascular events (MACE), but the duration of the high-risk time interval and the optimal prescription time frame for these interventions remains unknown. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: We performed a retrospective cohort study using data from medical services and hospitalizations in Manitoba, Canada for patients admitted with a MI between April 2006 and March 2010, and followed until Nov 30, 2014. We used survival analysis to determine the cumulative incidence of death, subsequent MI, or stroke, and used Cox proportional hazards models to assess factors associated with these endpoints. RESULTS: There were 8,493 patients in Manitoba admitted to hospital for a MI during the study period. Of those, 6,749 (79.5%) survived for at least 1 year without a recurrent MI or stroke. In the following year, this population remained at high risk, with 372 (5.5%) of the remaining patients dying in the next twelve months (48.1% cardiovascular deaths), 244 (3.6%) having a recurrent MI, and 74 (1.1%) having a stroke. Older age, male sex, diabetes, prior stroke, prior heart failure, prior unstable angina, and absence of revascularization were associated with worse long-term prognosis. CONCLUSIONS: The risk of MACE remains elevated among post-MI patients after the first year. Interventions to more intensively monitor, evaluate, and treat these patients should be considered beyond the first year following myocardial infarction.
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Tangri et al. (2017) conducted a cohort in Myocardial infarction (n=8,493). Post-myocardial infarction status was evaluated on Major adverse cardiovascular events (MACE), defined as the composite of non-fatal MI, non-fatal stroke, or CV death. Patients surviving one year post-myocardial infarction without a recurrent event remained at high risk, with 5.5% dying, 3.6% having a recurrent MI, and 1.1% having a stroke in the following year.
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