title: Long-term cardiovascular mortality after procedure-related or spontaneous myocardial infarction in patients with non-ST-segment elevation acute coronary syndrome: a collaborative analysis of individual patient data from the FRISC II, ICTUS, and RITA-3 trials (FIR).
abstract: BACKGROUND
  The present study was designed to investigate the long-term prognostic impact of procedure-related and spontaneous myocardial infarction (MI) on cardiovascular mortality in patients with non-ST-elevation acute coronary syndrome.
  
  
  RESULTS
  Five-year follow-up after procedure-related or spontaneous MI was investigated in the individual patient pooled data set of the FRISC-II (Fast Revascularization During Instability in Coronary Artery Disease), ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes), and RITA-3 (Randomized Intervention Trial of Unstable Angina 3) non-ST-elevation acute coronary syndrome trials. The principal outcome was cardiovascular death up to 5 years of follow-up. Cumulative event rates were estimated by the Kaplan-Meier method; hazard ratios were calculated with time-dependent Cox proportional hazards models. Adjustments were made for the variables associated with long-term outcomes. Among the 5467 patients, 212 experienced a procedure-related MI within 6 months after enrollment. A spontaneous MI occurred in 236 patients within 6 months. The cumulative cardiovascular death rate was 5.2% in patients who had a procedure-related MI, comparable to that for patients without a procedure-related MI (hazard ratio 0.66; 95% confidence interval, 0.36-1.20, P=0.17). In patients who had a spontaneous MI within 6 months, the cumulative cardiovascular death rate was 22.2%, higher than for patients without a spontaneous MI (hazard ratio 4.52; 95% confidence interval, 3.37-6.06, P<0.001). These hazard ratios did not change materially after risk adjustments.
  
  
  CONCLUSIONS
  Five-year follow-up of patients with non-ST-elevation acute coronary syndrome from the 3 trials showed no association between a procedure-related MI and long-term cardiovascular mortality. In contrast, there was a substantial increase in long-term mortality after a spontaneous MI.
authors.affiliation: Department of Cardiology, Cardiac Catheterization Laboratory B2-213, Academic Medical Center-University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands. p.damman@amc.uva.nl
authors.forename: Peter
authors.initials: P
authors.lastname: Damman
authors.forename: Lars
authors.initials: L
authors.lastname: Wallentin
authors.forename: Keith A A
authors.initials: KA
authors.lastname: Fox
authors.forename: Fons
authors.initials: F
authors.lastname: Windhausen
authors.forename: Alexander
authors.initials: A
authors.lastname: Hirsch
authors.forename: Tim
authors.initials: T
authors.lastname: Clayton
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Pocock
authors.forename: Bo
authors.initials: B
authors.lastname: Lagerqvist
authors.forename: Jan G P
authors.initials: JG
authors.lastname: Tijssen
authors.forename: Robbert J
authors.initials: RJ
authors.lastname: de Winter
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D000368:Aged; D001026:Coronary Artery Bypass / Q000401:mortality*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D009204:Myocardial Revascularization / Q000401:mortality*; D016032:Randomized Controlled Trials as Topic