title: Implications of prior myocardial infarction for patients presenting with an acute myocardial infarction.
abstract: BACKGROUND
  Prior myocardial infarction (MI) is a known risk factor for long-term mortality among acute MI patients; but its prevalence and implications for the short-term outcomes of patients with a new, acute MI remain uncertain.
  
  
  METHODS
  We studied a total of 319,152 consecutively enrolled ST-segment elevation MI (STEMI) and non-STEMI (NSTEMI) patients in the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines (01/2007-03/2012). Baseline characteristics, home and in-hospital treatments, mortality rates, and major bleeding were compared separately for STEMI and NSTEMI by prior MI status, with adjustment for mortality and major bleeding.
  
  
  RESULTS
  Prior MI was documented in 19% of STEMI (n = 124,535) and 29% of NSTEMI (n = 194,617) patients, who were older, were more likely to have comorbidities or prior revascularization, and were more commonly taking secondary prevention medications at home. Guideline-recommended treatments in-hospital and at discharge did not differ in prior-MI STEMI patients, but invasive management was lower for prior-MI NSTEMI patients. The frequency of in-hospital mortality was higher for prior-MI STEMI (5.9% vs. 5.2%) and NSTEMI patients (4.3% vs. 3.4%). After adjustment, the excess mortality risk associated with prior MI was no longer present for STEMI (odds ratio = 1.06, 95% CI 0.97-1.15), with only modest excess risk for NSTEMI (odds ratio = 1.10, 95% CI 1.04-1.15). The risk of in-hospital major bleeding was marginally lower for prior-MI NSTEMI.
  
  
  CONCLUSIONS
  More than 20% of patients with acute MI treated in contemporary practice have a history of a prior MI; despite differences in the baseline risk profile, there was little difference in the adjusted risk of in-hospital mortality by prior-MI status.
authors.affiliation: Duke Clinical Research Institute, Durham, NC; Shanghai Renji Hospital, Department of Cardiology, Shanghai, China.
authors.forename: Lan
authors.initials: L
authors.lastname: Shen
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Bimal R
authors.initials: BR
authors.lastname: Shah
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Aro
authors.initials: A
authors.lastname: Nam
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: DaJuanicia
authors.initials: D
authors.lastname: Holmes
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Karen P
authors.initials: KP
authors.lastname: Alexander
authors.affiliation: Veterans Affairs Boston Healthcare System, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA.
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.affiliation: Veterans Affairs Eastern Colorado Healthcare System, and University of Colorado, Denver, CO.
authors.forename: P Michael
authors.initials: PM
authors.lastname: Ho
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: Shanghai Renji Hospital, Department of Cardiology, Shanghai, China.
authors.forename: Ben
authors.initials: B
authors.lastname: He
authors.affiliation: Duke Clinical Research Institute, Durham, NC. Electronic address: matthew.roe@dm.duke.edu.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Roe
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D015331:Cohort Studies; D015897:Comorbidity; D017023:Coronary Angiography / Q000706:statistics & numerical data; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D017052:Hospital Mortality; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control* / Q000628:therapy; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012042:Registries; D012307:Risk Factors; D055502:Secondary Prevention / Q000706:statistics & numerical data; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D000925:Anticoagulants; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors