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Nonculprit Stenosis Evaluation Using Instantaneous Wave-Free Ratio in Patients With ST-Segment Elevation Myocardial Infarction Australian Trends in Procedural Characteristics and Outcomes in Patients Undergoing Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction Association of Silent Myocardial Infarction and Sudden Cardiac Death Diagnosis and Prognosis of Coronary Artery Disease with SPECT and PET Impact of tissue protrusion after coronary stenting in patients with ST-segment elevation myocardial infarction Characterization of lesions undergoing ischemia-driven revascularization after complete revascularization versus culprit lesion only in patients with STEMI and multivessel disease - A DANAMI-3-PRIMULTI substudy National Quality Assessment of Early Clopidogrel Therapy in Chinese Patients With Acute Myocardial Infarction (AMI) in 2006 and 2011: Insights From the China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE)-Retrospective AMI Study Effect of Plaque Burden and Morphology on Myocardial Blood Flow and Fractional Flow Reserve Early Natural History of Spontaneous Coronary Artery Dissection Universal Definition of Myocardial Infarction
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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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