title: Timing and long-term prognosis of recurrent MI after primary angioplasty : Stent thrombosis vs. non-stent-related reinfarction.
abstract: BACKGROUND
  In patients recovering from an ST-segment elevation myocardial infarction (STEMI), it is not clear whether the negative impact of stent thrombosis (ST) is different from a non-stent-related recurrent myocardial infarction (NSRMI). This study sought to assess the long-term incidence and prognostic impact of recurrent myocardial infarction (MI) after percutaneous coronary intervention (PCI) for STEMI by comparing outcomes of ST versus NSRMI.
  
  
  METHODS
  From 2001 to 2007, 1025 patients undergoing PCI for STEMI were prospectively followed up. Patients with ST, with NSRMI, and those free from recurrent MI were compared regarding mortality and major adverse cardiac and cerebrovascular events (MACCE).
  
  
  RESULTS
  Recurrent MI decreased from 37 events per 1000 person/months in the first month to 3.3 events per 1000 person/months after the first year. The cumulative 5‑year incidence of ST and NSRMI was 5.27 % and 13.2 %, respectively. MACCE at 60 months after recurrence were not significantly different for patients with reinfarction but were significantly higher than for patients free from any recurrent MI (both log-rank p < 0.001). However, the cumulative all-cause death rate did not differ between the three groups (27.8 vs. 26.7 vs. 23.0 %). Compared with ST occurring in the first 30 days after PCI for STEMI, early NSRMI was associated with a significantly reduced risk for all-cause death (HR, 0.21; 95 % CI, 0.33-3.30) but this association did not persist for recurrent MIs occurring in the late (HR, 1.05; 95 % CI, 0.33-3.30) or very late follow-up periods.
  
  
  CONCLUSIONS
  Although ST was associated with a significant increase in adverse events in the early recovery period, in the long term, MACCE and all-cause mortality rates were comparable to those for NSRMI.
authors.affiliation: Cardiology Department, Hospital of Santa Marta, Rua de Santa Marta, 1169-1024, Lisbon, Portugal. andreviveirosmonteiro@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Viveiros Monteiro
authors.affiliation: Cardiology Department, Hospital of Santa Marta, Rua de Santa Marta, 1169-1024, Lisbon, Portugal.
authors.forename: R
authors.initials: R
authors.lastname: Ramos
authors.affiliation: Cardiology Department, Hospital of Santa Marta, Rua de Santa Marta, 1169-1024, Lisbon, Portugal.
authors.forename: A
authors.initials: A
authors.lastname: Fiarresga
authors.affiliation: Cardiology Department, Hospital of Santa Marta, Rua de Santa Marta, 1169-1024, Lisbon, Portugal.
authors.forename: L
authors.initials: L
authors.lastname: de Sousa
authors.affiliation: Cardiology Department, Hospital of Santa Marta, Rua de Santa Marta, 1169-1024, Lisbon, Portugal.
authors.forename: D
authors.initials: D
authors.lastname: Cacela
authors.affiliation: Cardiology Department, Hospital of Santa Marta, Rua de Santa Marta, 1169-1024, Lisbon, Portugal.
authors.forename: L
authors.initials: L
authors.lastname: Patrício
authors.affiliation: Cardiology Department, Hospital of Santa Marta, Rua de Santa Marta, 1169-1024, Lisbon, Portugal.
authors.forename: L
authors.initials: L
authors.lastname: Bernardes
authors.affiliation: Cardiology Department, Hospital of Santa Marta, Rua de Santa Marta, 1169-1024, Lisbon, Portugal.
authors.forename: C
authors.initials: C
authors.lastname: Soares
authors.affiliation: Cardiology Department, Hospital of Santa Marta, Rua de Santa Marta, 1169-1024, Lisbon, Portugal.
authors.forename: R
authors.initials: R
authors.lastname: Cruz Ferreira
mesh_terms: D017677:Age Distribution; D015984:Causality; D003131:Combined Modality Therapy / Q000401:mortality / Q000706:statistics & numerical data; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000401:mortality*; D011174:Portugal / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D015607:Stents / Q000706:statistics & numerical data*; D015996:Survival Rate; D013927:Thrombosis / Q000401:mortality* / Q000517:prevention & control; D016896:Treatment Outcome
keywords: Myocardial infarction; Primary percutaneous coronary intervention; ST-segment elevation; Stent thrombosis