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Timing and long-term prognosis of recurrent MI after primary angioplasty

Stent thrombosis vs. non-stent-related reinfarction

Timing und Langzeitprognose bei rekurrierendem Myokardinfarkt nach primärer Angioplastik

Stentthrombose vs. nicht stentbedingtem Reinfarkt

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Abstract

Background

In patients recovering from an ST-segment elevation myocardial infarction (STEMI), it is not clear whether the negative impact of stent thrombosis (ST) is different from a non-stent-related recurrent myocardial infarction (NSRMI). This study sought to assess the long-term incidence and prognostic impact of recurrent myocardial infarction (MI) after percutaneous coronary intervention (PCI) for STEMI by comparing outcomes of ST versus NSRMI.

Patients and methods

From 2001 to 2007, 1025 patients undergoing PCI for STEMI were prospectively followed up. Patients with ST, with NSRMI, and those free from recurrent MI were compared regarding mortality and major adverse cardiac and cerebrovascular events (MACCE).

Results

Recurrent MI decreased from 37 events per 1000 person/months in the first month to 3.3 events per 1000 person/months after the first year. The cumulative 5‑year incidence of ST and NSRMI was 5.27 % and 13.2 %, respectively. MACCE at 60 months after recurrence were not significantly different for patients with reinfarction but were significantly higher than for patients free from any recurrent MI (both log-rank p < 0.001). However, the cumulative all-cause death rate did not differ between the three groups (27.8 vs. 26.7 vs. 23.0 %). Compared with ST occurring in the first 30 days after PCI for STEMI, early NSRMI was associated with a significantly reduced risk for all-cause death (HR, 0.21; 95 % CI, 0.33–3.30) but this association did not persist for recurrent MIs occurring in the late (HR, 1.05; 95 % CI, 0.33–3.30) or very late follow-up periods.

Conclusion

Although ST was associated with a significant increase in adverse events in the early recovery period, in the long term, MACCE and all-cause mortality rates were comparable to those for NSRMI.

Zusammenfassung

Hintergrund

Bei Patienten, die sich von einem ST-Streckenerhebungsinfarkt (STEMI) erholen, ist es nicht klar, ob sich die negativen Auswirkungen der Stentthrombose (ST) von einem nicht stentbedingten rekurrierenden Myokardinfarkt (NSRMI) unterscheiden. Diese Studie untersuchte die Langzeitinzidenz und die prognostischen Auswirkungen eines rekurrierenden Myokardinfarkts (MI) nach perkutaner koronarer Intervention (PCI) wegen STEMI, indem die ST- mit den NSRMI-Outcomes verglichen wurden.

Patienten und Methoden

Von 2001 bis 2007 wurden 1025 Patienten, die sich einer PCI wegen STEMI unterzogen, prospektiv untersucht. Patienten mit ST oder NSRMI sowie Patienten ohne rekurrierenden MI wurden bezüglich Mortalität und schweren unerwünschten kardialen Ereignissen („major adverse cardiac and cerebrovascular events“, MACCE) verglichen.

Ergebnisse

Rekurrierende MI verringerten sich nach einem Jahr von 37 Ereignissen pro 1000 Personen/Monat im ersten Monat auf 3,3 Ereignisse pro 1000 Personen/Monat. Die kumulative 5‑Jahres-Inzidenz von ST und NSRMI lag bei 5,27 % bzw. 13,2 %. Die MACE unterschieden sich 60 Monate nach dem Wiederauftreten nicht signifikant von Patienten mit einem Reinfarkt, sie waren jedoch signifikant höher als bei Patienten ohne rekurrierenden MI (beide Log-Rank p < 0,001). Jedoch gab es bei der kumulativen Gesamtmortalitätsrate keinen Unterschied zwischen den drei Gruppen (27,8 vs. 26,7 vs. 23,0 %). Verglichen mit einer ST, die in den ersten 30 Tagen nach PCI wegen STEMI auftrat, waren NSRMI mit einem signifikant geringeren Risiko für die Gesamtmortalität assoziiert (HR 0,21; 95 % KI 0,33–3,30). Diese Assoziation hielt allerdings bei rekurrierenden MIs im späteren (HR 1,05; 95 % KI 0,33–3,30) oder sehr späten Follow-up-Zeitraum nicht an.

Schlussfolgerung

Obwohl ST in der frühen Erholungsphase mit einem signifikanten Anstieg unerwünschter Ereignisse assoziiert waren, waren die Langzeit-MACE und Gesamtmortalitätsraten mit denen für NSRMI vergleichbar.

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Authors and Affiliations

  1. Cardiology Department, Hospital of Santa Marta, Rua de Santa Marta, 1169-1024, Lisbon, Portugal

    A. Viveiros Monteiro MD, R. Ramos, A. Fiarresga, L. de Sousa, D. Cacela, L. Patrício, L. Bernardes, C. Soares & R. Cruz Ferreira

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  1. A. Viveiros Monteiro MD
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  2. R. Ramos
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  3. A. Fiarresga
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  4. L. de Sousa
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Correspondence to A. Viveiros Monteiro MD.

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Conflict of interest

A. Viveiros Monteiro, R. Ramos, A. Fiarresga, L. de Sousa, D. Cacela, L. Patricio, L. Bernardes, C. Soares, and R. Cruz Rerreira state that there are no conflicts of interest.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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A. Viveiros Monteiro and R. Ramos contributed equally to this work.

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Viveiros Monteiro, A., Ramos, R., Fiarresga, A. et al. Timing and long-term prognosis of recurrent MI after primary angioplasty. Herz 42, 186–193 (2017). https://doi.org/10.1007/s00059-016-4446-0

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  • DOI: https://doi.org/10.1007/s00059-016-4446-0

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