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.