title: Nonfatal myocardial infarction and long-term outcomes in coronary artery disease.
abstract: BACKGROUND
  Therapies may reduce short-term rates of nonfatal myocardial infarction (MI) without a detectable effect on mortality. We sought to estimate the long-term clinical implications of nonfatal MI occurring within the first 3 and 6 months after initial cardiac catheterization.
  
  
  METHODS
  We included consecutive patients with significant coronary artery disease (≥75% stenosis in ≥1 epicardial segments) undergoing diagnostic catheterization between January 1, 1999, and September 30, 2006. Landmark analyses were performed for patients surviving at 3- and 6-month follow-up. At these times, patients were divided into groups based upon occurrence of a nonfatal MI subsequent to catheterization.
  
  
  RESULTS
  Among 14,890 patients alive at 3 months (669 with MI and 14,221 without an MI), having an MI during the initial 3-month period was a significant predictor of reduced 4-year survival (77.1% vs 83.5%, hazard ratio 1.40, 95% CI 1.21-1.63, P < .001), survival free of MI (68.4% vs 78.5%, hazard ratio 1.50, 95% CI 1.32-1.71, P < .001), and survival free of MI or revascularization (59.7% vs 68.5%, hazard ratio 1.34, 95% CI 1.19-1.51, P < .001). Adjusted hazard ratios were similar for patients surviving to 6 months (804 with MI and 13,842 without an MI).
  
  
  CONCLUSIONS
  Nonfatal MIs occurring within the first 3 and 6 months after diagnostic catheterization are associated with a significant increase in the risk for subsequent clinical events. Clinical studies with limited follow-up periods may underestimate the long-term value of therapies that reduce early MI rates as downstream benefits continue to accrue over time.
authors.affiliation: Duke Clinical Research Institute, Outcomes, Durham, NC 27705, USA. eric.eisenstein@duke.edu
authors.forename: Eric L
authors.initials: EL
authors.lastname: Eisenstein
authors.forename: David F
authors.initials: DF
authors.lastname: Kong
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Cowper
authors.forename: Jay P
authors.initials: JP
authors.lastname: Bae
authors.forename: Krishnan
authors.initials: K
authors.lastname: Ramaswamy
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Anstrom
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization; D003324:Coronary Artery Disease / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D009657:North Carolina / Q000453:epidemiology; D012042:Registries; D012307:Risk Factors; D016019:Survival Analysis