title: Prognostic significance of nonfatal myocardial reinfarction in survivors of a first infarction.
abstract: BACKGROUND
  Patients who develop a reinfarction are at increased risk for subsequent reinfarctions and death. However, follow-up studies in these patients are rare.
  
  
  OBJECTIVE
  The purpose of this study was to examine the risk of mortality after a first myocardial reinfarction and to determine the independent contribution of nonfatal reinfarction to the risk of subsequent mortality.
  
  
  METHODS
  The prognostic value of nonfatal reinfarction was assessed in a large series (n=3097) of patients with a first myocardial infarction who participated in the ASPECT trial, comparing coumarin or matching placebo.
  
  
  RESULTS
  A second myocardial infarction was documented in 299 patients (82% Q-wave infarctions), 45 (15%) of which were fatal. Of the 254 nonfatal reinfarctions, 31 patients (12%) died during subsequent follow-up. After adjustment for baseline characteristics, the relative risks of nonfatal reinfarction for subsequent cardiac mortality at one month were: 2.90 (1.49-5.64), at one year: 2.50 (1.47-4.23) and at three years: 2.71 (1.77-4.17). Rates of death or a second reinfarction in patients who did not undergo a revascularisation procedure after a first reinfarction were almost three times higher than in patients who did have PTCA or bypass surgery after a reinfarction (38% versus 14%; p<0.0001).
  
  
  CONCLUSIONS
  This study population with three-year follow-up confirms that nonfatal reinfarction carries a strong and independent risk for recurrent reinfarction and subsequent mortality. Thus, prevention of reinfarction by intensive treatment might contribute in reduction of mortality.
authors.forename: R T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: J W
authors.initials: JW
authors.lastname: Deckers
authors.forename: P F M M
authors.initials: PF
authors.lastname: van Bergen
authors.forename: A J
authors.initials: AJ
authors.lastname: Azar
authors.forename: J J C
authors.initials: JJ
authors.lastname: Jonker
authors.forename: M L
authors.initials: ML
authors.lastname: Simoons
keywords: mortality; myocardial infarction; prognosis; revascularisation; risk factors