title: Predictors and Impact of In-Hospital Recurrent Myocardial Infarction in Patients With Acute Coronary Syndrome: Findings From Gulf RACE-2.
abstract: BACKGROUND
  Little is known about the predictors and prognostic impact of recurrent in-hospital ischemia and infarction in patients with acute coronary syndrome (ACS). Our objectives were to determine the baseline characteristics, risk factors, and long-term outcomes of patients with recurrent myocardial infarction (Re-MI).
  
  
  METHODS
  We evaluated patients with ACS who were enrolled in the second Gulf Registry of Acute Coronary Events from October 2008 to June 2009.
  
  
  RESULTS
  Of 7925 patients with ACS, 167 (2.1%) developed in-hospital Re-MI. Patients with Re-MI were older (mean age: 58.7 ± 13.4 vs 56.8 ± 12.6; P = .045), had higher rates of hyperlipidemia (42.5% vs 32.6%; P = .019), and were more likely to present with ST-segment elevation myocardial infarction (STEMI; 74.25% vs 43.9%; P < .001) and Killip class 4 (8.4% vs 3.2%; P < .001) than patients without Re-MI. Patients with Re-MI were less likely to receive evidence-based therapies upon admission, including aspirin (94.6% vs 98.5%; P < .001), β-blockers (59.3% vs 74.7%; P < .001), and statins (86.8% vs 94.9%; P < .001), and were less frequently assessed with coronary angiography (29.3% vs 32.5%; P = .029). Predictors of recurrent events included history of angina, hypotension on presentation, admission diagnosis of STEMI, and decreased use of evidence-based therapies including aspirin, statins, and β-blockers upon admission. Patients with Re-MI had more in-hospital complications, including congestive heart failure (44.3% vs 12.4%) and cardiogenic shock (26.4% vs 5.3%), as well as higher mortality rates during hospitalization (23.4% vs 4.1%) and after a discharge period of 30 days (27% vs 7.8%) and 1 year (30.5% vs 11.7%; P < .001 for all comparisons).
  
  
  CONCLUSIONS
  In our study, patients with Re-MI were less likely to receive evidence-based therapies and had a worse prognosis in terms of in-hospital complications and higher mortality rates. High-risk patients should be monitored and managed differently to prevent secondary attacks.
authors: 1 Department of Cardiac Sciences, King Fahad Cardiac Centre, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors: Abdullah S
authors: AS
authors: Al Saleh
authors: 1 Department of Cardiac Sciences, King Fahad Cardiac Centre, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors: Khalid F
authors: KF
authors: Alhabib
authors: 2 Department of Cardiology, Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
authors: Alawi A
authors: AA
authors: Alsheik-Ali
authors: 3 Department of Cardiology, Royal Hospital, Muscat, Oman.
authors: Khadim
authors: K
authors: Sulaiman
authors: 1 Department of Cardiac Sciences, King Fahad Cardiac Centre, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors: Hussam
authors: H
authors: Alfaleh
authors: 4 Department of Cardiology, Saud AlBabtain Cardiac Centre, Dammam, Saudi Arabia.
authors: Shukri
authors: S
authors: Alsaif
authors: 2 Department of Cardiology, Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
authors: Wael
authors: W
authors: Al Mahmeed
authors: 5 Department of Cardiology and Cardiovascular Surgery, Hamad General Hospital, Doha, Qatar.
authors: Nidal
authors: N
authors: Asaad
authors: 6 Department of Cardiology, Mohammed Bin Khalifa Cardiac Centre, Manama, Bahrain.
authors: Haiham
authors: H
authors: Amin
authors: 7 Faculty of Medicine, Sana'a University, Sana'a, Yemen.
authors: Ahmed
authors: A
authors: Al-Motarreb
authors: 5 Department of Cardiology and Cardiovascular Surgery, Hamad General Hospital, Doha, Qatar.
authors: Jassim
authors: J
authors: Al Suwaidi
authors: 1 Department of Cardiac Sciences, King Fahad Cardiac Centre, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors: Ahmad S
authors: AS
authors: Hersi
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications*; D015897:Comorbidity; D017023:Coronary Angiography; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D008877:Middle East / Q000453:epidemiology; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy; D011379:Prognosis; D012008:Recurrence; D012042:Registries; D012307:Risk Factors
keywords: ACS; Gulf RACE-2; and recurrent MI