The incidence and predictors of major adverse cardiovascular events in stable patients after acute myocardial infarction

Abstract Background/aim Although the highest risk for mortality and other adverse events is in the first months or first year after acute myocardial infarction, the risk for subsequent adverse events is not negligible. The aim of this study is to determine predictors of all-cause mortality and major adverse cardiovascular events (MACE comprising recurrent infarction, ischemic stroke and cardiovascular death) in patients who had ST-elevation myocardial infarction (STEMI) and who were event-free (stable) in the first year of follow-up. Method we analyzed consecutive STEMI patients who were included in the Clinical center of Serbia STEMI Register from the 1st of December 2005 until the 31st of December 2016. All patients were treated with primary PCI. Patients with cardiogenic shock at admission were excluded from the register. Patients were followed-up at 8 years after the index event. Results : From the 1st December 2005 and 31st December of January 2016 a total of 3079 patients were included in the Register. In the first year, MACE was registered in 348(11.3%) patients. The remaining 2.731 patients were considered stable and they were included in further analysis. Among analyzed stable patients 1915 (70.1%) patients were male and the median age of analyzed patients was 59(57, 61) years. At eight years rates MACE was registered in107 (3.9%) patients, non-fatal recurrent infarction in 57(2.1%) patients, TVR in 49(1.8%) patients, non-fatal stroke in 14(0,5%) patients and 57( 2.1%) patients died. During entire follow-up of up to eight years, the incidence of MACE in stable patients gradually increased, without excess, as shown in Figure 1 .Compared with stable patients without MACE, those who had MACE were older, more often had previous coronary disease, diabetes, hypertension and lower left ventricular ejection fraction (EF) at discharge and multivessel coronary artery disease. Receiver operating characteristics curve (ROC) analysis revealed that 60 years was the most powerful predictive age for the occurrence of analyzed composite CV events in our patients. Predictors for 8-year MACE in stable patients were age 60 years (60-69vs60 years HR 1.65 95%CI 1,06-2.37; 70-79 vs60 years HR 1.82 95%CI 1.05-3.20; ≥80vs60 years HR 3.16 95%CI 1.11-9.65), EF50% (EF 40-49% HR 2.32 95%CI 1.31-2.39; EF40% HR 2.38 95%CI 1.36-4.14 ), diabetes mellitus (HR 1.49 95%CI 1.09-2.31) and 3-vessel coronary artery disease (HR 1.44 95%CI 1.06-2.43).. Conclusion Although the incidence of subsequent adverse events in long-term follow-up was low, four predictors identified stable patients post-STEMI patients who remained at higher risk. Stable post-STEMI patients with one or more of these risk factors may require more aggressive secondary prevention measures or a personalized treatment approach to improve their prognosis.Figure 1 Figure 2