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Frequency of nonsystem delays in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention and implications for door-to-balloon time reporting (from the American Heart Association Mission: Lifeline program) Changes in One-Year Mortality in Elderly Patients Admitted with Acute Myocardial Infarction in Relation with Early Management Effect of improved door-to-balloon time on clinical outcomes in patients with ST segment elevation myocardial infarction Prevalence of Coronary Vasospasm Using Coronary Reactivity Testing in Patients With Spontaneous Coronary Artery Dissection 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes: The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC) Prognostic Value of the Residual SYNTAX Score After Functionally Complete Revascularization in ACS Decade-Long Trends (2001 to 2011) in the Use of Evidence-Based Medical Therapies at the Time of Hospital Discharge for Patients Surviving Acute Myocardial Infarction Non-eligibility for reperfusion therapy in patients presenting with ST-segment elevation myocardial infarction: Contemporary insights from the National Cardiovascular Data Registry (NCDR) Complete Revascularization with Multivessel PCI for Myocardial Infarction Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis
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Original ResearchEpub January 19, 2018

JOURNAL：Am J Cardiol. Article Link

Recurrent Cardiovascular Events in Survivors of Myocardial Infarction with St-Segment Elevation (From the AMI-QUEBEC Study)

T. Huynh, M. Montigny, U. Iftikhar et al. Keywords: Acute Myocardial Infarction, Acute Coronary Syndromes, Percutaneous Coronary Intervention, Reperfusion Therapy

ABSTRACT

The characteristics and predictors of long-term recurrent ischemic cardiovascular events (RICE) following myocardial infarction with ST-segment elevation (STEMI) have not yet been clarified. We aimed to characterize the 10-year incidence, types, and predictors of RICE. We obtained 10-year follow-up of STEMI survivors at 17 Quebec hospitals in Canada (the AMI-QUEBEC Study) in 2003. There were 858 patients; mean age of 60 years and 73% males. The majority of patients receive reperfusion therapy with 53.3% and 39.2% received primary PCI and fibrinolytic therapy, respectively. Seventy-five percent of patients underwent in-hospital PCI (elective, rescue and primary). At 10-year, 42% of patients suffered a RICE with most RICEs (88%) caused by recurrent cardiac ischemia. The risk of RICE was the highest during the first year (23.5 per person-year). At 10-year, the all-cause mortality was 19.3% with one-third of deaths being RICE-related. Prior CV event, heart failure during the index STEMI hospitalization, discharge prescription of calcium-blocker increased the risk of RICE by almost two-fold. Each point increase in Thrombolysis in Myocardial Infarction (TIMI) score augmented the risk of RICE by 6% while discharge prescription of dual anti-platelets reduced the risk of RICE by 23%. Our findings suggested that survivors of STEMI remain at high long-term risk of RICE despite high rate of reperfusion therapy and in-hospital PCI. Patients with prior CV event, in-hospital heart failure and high TIMI score were particularly susceptible to RICE. Future studies are needed to confirm the impacts of calcium-blocker and dual anti-platelets on long-term risk of RICE.
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