title: Treatment and outcomes of patients with recurrent myocardial infarction: A prospective observational cohort study.
abstract: Little is known about differences in therapies and outcomes of patients with first myocardial infarction (MI) or recurrent MI (reMI). This study aimed to evaluate the impact of prior MI on therapies and outcomes in patients who presented with ST-elevation MI (STEMI).
  
  
  
  All STEMI patients enrolled from 2002 to 2014 in the AMIS Plus registry were included. Outcome was analyzed using logistic multivariate regression.
  
  
  
  From 19,665 STEMI patients, 2845 (14%) had reMI. These patients were older (69.5y vs. 64.2y; p<0.001), more frequently male, with more risk factors (hypertension, dyslipidemia), and more comorbidities. Patients with reMI presented 25min earlier than those with first MI, were more frequently in Killip class 3/4 (12% vs. 7%; p<0.001), and were less likely to receive guideline-recommended drug therapy: aspirin (93% vs. 97%; p<0.001), P2Y12inhibitors (76% vs. 83%; p<0.001), or statins (73% vs. 77%; p<0.001), or undergo primary percutaneous coronary intervention (77% vs. 87%; p<0.001). These patients developed more frequently cardiogenic shock (7% vs. 5%; p<0.001) and reinfarction (2% vs. 1%; p<0.001) during hospitalization, and had higher crude mortality (10% vs. 5%; p<0.001) than patients without prior MI. Prior MI was an independent predictor of in-hospital mortality in STEMI patients (OR 1.27; 95% CI 1.05-1.53; p<0.001). A subgroup (n=4486) was followed 1 year after discharge (3893 with first MI and 593 with reMI at initial hospitalization). Crude mortality was 2.9% for patients with first MI vs. 6.7% for those with reMI (OR 1.68, 95% CI 1.14-2.47; p=0.008).
  
  
  
  Although patients with reMI are high-risk patients, they were less likely to receive evidence-based treatment and had worse in-hospital and 1-year outcomes compared to patients with first MI. Short- and long-term management of patients with recurring MI should be improved.
authors.affiliation: AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland. Electronic address: dragana.radovanovic@uzh.ch.
authors.forename: Dragana
authors.initials: D
authors.lastname: Radovanovic
authors.affiliation: AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
authors.forename: Lea
authors.initials: L
authors.lastname: Maurer
authors.affiliation: Cardiology Center, Klinik im Park, Zurich, Switzerland.
authors.forename: Osmund
authors.initials: O
authors.lastname: Bertel
authors.affiliation: AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Witassek
authors.affiliation: Cardiovascular Department, La Tour Hospital, Geneva, Switzerland.
authors.forename: Philip
authors.initials: P
authors.lastname: Urban
authors.affiliation: Service de Cardiologie, Hôpital Cantonal, Fribourg, Switzerland.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Stauffer
authors.affiliation: Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pedrazzini
authors.affiliation: AMIS Plus, Zurich, Switzerland.
authors.forename: Paul
authors.initials: P
authors.lastname: Erne
mesh_terms: D000367:Age Factors; D000368:Aged; D001241:Aspirin / Q000627:therapeutic use; D015331:Cohort Studies; D015897:Comorbidity; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence; D017052:Hospital Mortality; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D058921:Purinergic P2Y Receptor Antagonists / Q000627:therapeutic use; D012008:Recurrence; D012042:Registries; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D012737:Sex Factors; D012770:Shock, Cardiogenic / Q000401:mortality; D013557:Switzerland / Q000453:epidemiology
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D001241:Aspirin
keywords: Acute myocardial infarction; Outcome; Recurrent myocardial infarction; STEMI; Treatment