Abstract
Background
Despite improved secondary prevention efforts, acute coronary syndrome (ACS) recurrence among patients with prior history of coronary events remains high. The differences in presentation, management, and subsequent clinical outcomes in patients with and without a prior myocardial infarction (MI) and presenting with another episode of ACS remain unexplored.
Methods
A total of 3,624 consecutive patients admitted to the University of Michigan with ACS from January 1999 to June 2006 were studied retrospectively. In‐hospital management, outcomes, and postdischarge outcomes such as death, stroke, and reinfarction in patients with and without a prior MI were compared.
Results
Patients with a prior MI were more likely to be older and have a higher incidence of diabetes mellitus, hypertension, hyperlipidemia, and peripheral vascular disease. In‐hospital outcomes were not significantly different in the 2 groups, except for a higher incidence of cardiac arrest (4.3% versus 2.5%, p < 0.01) and cardiogenic shock (5.7% versus 3.9%, p = 0.01) among patients without a prior MI. However, at 6 mo postdischarge, the incidences of death (8.0% versus 4.5%, p < 0.0001) and recurrent MI (10.0% versus 5.1%, p < 0.0001) were significantly higher in patients with a prior history of MI compared with those without.
Conclusion
Patients with prior MI with recurrent ACS remain at a higher risk of major adverse events on follow‐up. This may be partly explained by the patients not being on optimal medications at presentation, as well as disease progression. Increased efforts must be directed at prevention of recurrent ACS, as well as further risk stratification of these patients to improve their overall outcomes. Copyright © 2008 Wiley Periodicals, Inc.
Keywords: recurrent acute coronary syndrome, outcomes, prior myocardial infarction
Full Text
The Full Text of this article is available as a PDF (344.7 KB).
References
- 1. Roe MT, Peterson ED, Newby LK, Chen AY, Pollack CV Jr, et al.: The influence of risk status on guideline adherence for patients with non‐ST‐segment elevation acute coronary syndromes. Am Heart J 2006; 151(6): 1205–1213. [DOI] [PubMed] [Google Scholar]
- 2. Boersma E, Pieper KS, Steyerberg EW, Wilcox RG, Chang WC, et al.: Predictors of outcome in patients with acute coronary syndromes without persistent ST‐segment elevation. Results from an international trial of 9,461 patients. The PURSUIT Investigators. Circulation 2000; 101(22): 2557–2567. [DOI] [PubMed] [Google Scholar]
- 3. Eagle KA, Lim MJ, Dabbous OH, Pieper KS, Goldberg RJ, et al.: A validated prediction model for all forms of acute coronary syndrome. JAMA 2004; 291: 2727–2733. [DOI] [PubMed] [Google Scholar]
- 4. Granger CB, Goldberg RJ, Dabbous O, Pieper KS, Eagle Ka, et al.: Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med 2003; 163(19): 2345–2353. [DOI] [PubMed] [Google Scholar]
- 5. Szygula‐Jurkiewicz B, Wojnicz R, Trzeciak P, Niklewski T, Zembala M, et al.: Clinical characteristics, in‐hospital outcomes and predictors of in‐hospital mortality in patients with acute coronary syndromes without persistent ST‐segment elevation assigned to early invasive treatment strategy. Przegl Lek 2005; 62(5): 265–269. [PubMed] [Google Scholar]
- 6. Emond M, Mock MB, Davis KB, Fisher LD, Holmes DR Jr, et al.: Long‐term survival of medically treated patients in the Coronary Artery Surgery Study (CASS) registry. Circulation 1994; 90: 2645–2657. [DOI] [PubMed] [Google Scholar]
- 7. Brezinski D, Stone PH, Muller JE, Tofler GH, Davis V, et al.: Prognostic significance of the Karnofsky performance status score in patients with acute myocardial infarction: Comparison with the left ventricular ejection fraction and the exercise treadmill test performance. The MILIS study group. Am Heart J 1991; 121: 1374–1381. [DOI] [PubMed] [Google Scholar]
- 8. Bosch X, Theroux P; Left ventricular ejection fraction to predict early mortality in patients with non‐ST‐segment elevation acute coronary syndromes. Am Heart J 2005; 150(2): 215–220. [DOI] [PubMed] [Google Scholar]
- 9. Devlin G, Anderson FA, Heald S, Lopez‐Sendon J, Avezum A, et al.: Management and outcomes of lower risk patients presenting with acute coronary syndromes in a multinational observational registry. Heart 2005; 91(11): 1394–1399. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10. Lee KL, Woodlief LH, Topol EJ, Weaver WD, Betriu A, et al.: Predictors of 30‐day mortality in the era of reperfusion for acute myocardial infarction: Results from an international trial of 41,021 patients. Circulation 1995; 91: 1659–1668. [DOI] [PubMed] [Google Scholar]
- 11. Eagle KA, Lim MJ, Dabbous OH, Pieper KS, Goldberg RJ, et al.: A validated prediction model for all forms of acute coronary syndrome: Estimating the risk of 6‐month postdischarge death in an international registry. JAMA 2004; 291: 2727–2733. [DOI] [PubMed] [Google Scholar]