title: Cardiovascular risk in post-myocardial infarction patients: nationwide real world data demonstrate the importance of a long-term perspective.
abstract: OBJECTIVE
  Long-term disease progression following myocardial infarction (MI) is not well understood. We examined the risk of subsequent cardiovascular events in patients discharged after MI in Sweden.
  
  
  RESULTS
  This was a retrospective, cohort study linking morbidity, mortality, and medication data from Swedish national registries. Of 108 315 patients admitted to hospital with a primary MI between 1 July 2006 and 30 June 2011 (index MI), 97 254 (89.8%) were alive 1 week after discharge and included in this study. The primary composite endpoint of risk for non-fatal MI, non-fatal stroke, or cardiovascular death was estimated for the first 365 days post-index MI and Day 366 to study completion. Risk and risk factors were assessed by Kaplan-Meier analysis and Cox proportional hazards modelling, respectively. Composite endpoint risk was 18.3% during the first 365 days post-index MI. Age [60-69 vs. <60 years: HR (95% CI): 1.37 (1.30-1.45); 70-79 vs. <60 years: 2.13 (2.03-2.24); >80 vs. <60 years: 3.96 (3.78-4.15)], prior MI [1.44 (1.40-1.49)], stroke [1.49 (1.44-1.54)], diabetes [1.37 (1.34-1.40)], heart failure [1.57 (1.53-1.62)] and no index MI revascularisation [1.88 (1.83-1.93)] were each independently associated with a higher risk of ischaemic events or death. For patients without a combined endpoint event during the first 365 days, composite endpoint risk was 20.0% in the following 36 months.
  
  
  CONCLUSIONS
  Risk of cardiovascular events appeared high beyond the first year post-MI, indicating a need for prolonged surveillance, particularly in patients with additional risk factors.
authors.affiliation: Department of Medicine, Huddinge, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, 141 86 Stockholm, Sweden tomas.jernberg@karolinska.se.
authors.forename: Tomas
authors.initials: T
authors.lastname: Jernberg
authors.affiliation: AstraZeneca NordicBaltic, Södertälje, Sweden.
authors.forename: Pål
authors.initials: P
authors.lastname: Hasvold
authors.affiliation: AstraZeneca NordicBaltic, Södertälje, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Henriksson
authors.affiliation: Nyköping Hospital, Nyköping, Sweden.
authors.forename: Hans
authors.initials: H
authors.lastname: Hjelm
authors.affiliation: Statisticon AB, Uppsala, Uppsala 753 22, Sweden.
authors.forename: Marcus
authors.initials: M
authors.lastname: Thuresson
authors.affiliation: Department of Cardiology, Linköping University, Linköping, Sweden Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Janzon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000401:mortality*; D018450:Disease Progression; D004812:Epidemiologic Methods; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality; D020521:Stroke / Q000401:mortality; D013548:Sweden / Q000453:epidemiology
keywords: Mortality; Myocardial infarction; Nationwide register data; Prognosis; Risk factors