March 28, 2019Open Access
Unsatisfactory risk factor control and high rate of new cardiovascular events in patients with myocardial infarction and prior coronary artery disease
Key Result
Patients with myocardial infarction and prior coronary artery disease had a significantly increased risk of death or new MI compared to patients without prior CAD (adjusted HR 1.6).
Study Design
Type
Cohort (n=28,607)
Multicenter
Yes
Structured PICO
Does prior coronary artery disease increase the risk of recurrent myocardial infarction or death in patients presenting with a new Type 1 myocardial infarction?
P
Population
28,607 patients < 80 years old admitted to Norwegian hospitals with Type 1 myocardial infarction from 2013 to 2016, registered in the Norwegian Myocardial Infarction Register (NORMI).
I
Intervention
Prior coronary artery disease (exposure)
C
Comparator
No prior coronary artery disease
O
Outcome
Composite of all-cause mortality or new myocardial infarction during follow-upcomposite
In patients presenting with a Type 1 myocardial infarction, a history of prior coronary artery disease is associated with poor secondary prevention target attainment and a significantly higher risk of recurrent MI or death.
Main Result
Effect estimate: HR 1.6 (95% CI 1.5-1.7)
Absolute Event Rate: 30% vs 14.7%
p-value: p=<0.001
Limitations
- Observational study design precludes demonstrating causal associations
- Only MIs that led to hospitalization were registered
- Incomplete coverage for variables such as BMI, LDL cholesterol, and HbA1c
- Blood pressures were not obtained in a standardized setting
- No information regarding cardiac rehabilitation programs or specific causes of death
Abstract
Patients with established coronary artery disease (CAD) have an increased risk of new cardiovascular events. An underuse of secondary preventive drugs has been observed, and many patients may not attain the treatment goals for secondary prevention. The aims of the present nationwide register-based cohort study were to assess the degree of risk factor control and long-term outcomes in patients < 80 years with Type 1 myocardial infarction (MI) with and without prior CAD. Data concerning all patients with MI admitted to hospitals in Norway from 2013 to 2016 were retrieved from the Norwegian Myocardial Infarction Register (NORMI). Long-term mortality was obtained through linkage with the Norwegian Cause of Death Registry. In total, 47,204 patients were registered in the NORMI from 2013 to 2016. Prior CAD was recorded in 7219 (25.2%) of the 28,607 patients < 80 years old with Type 1 MIs. On average, 3 of the 6 defined treatment targets for secondary preventive therapy were attained, and only 1% of the patients achieved all targets. Patients with MI and prior CAD had increased risk of death or new MI compared to patients without prior CAD during long-term follow-up (adjusted HR 1.6, 95% CI 1.5–1.7). Prior CAD was frequent in patients with acute MI. The attainment of secondary preventive treatment targets in patients with MI and prior CAD was not optimal, and the long-term outcomes were reduced compared to patients without prior CAD. Increased efforts to improve risk factor control are needed.