Secondary prevention strategies after an acute ST-segment elevation myocardial infarction in the AMI code era: beyond myocardial mechanical reperfusion.
BACKGROUND
The AMI code is a regional network enhancing a rapid and widespread access to reperfusion therapy (giving priority to primary angioplasty) in patients with acute ST-segment elevation myocardial infarction (STEMI). We aimed to assess the long-term control of conventional cardiovascular risk factors after a STEMI among patients included in the AMI code registry.


METHODS
Four hundred and fifty-four patients were prospectively included between June-2009 and April-2013. Clinical characteristics were collected at baseline. The long-term control of cardiovascular risk factors and cardiovascular morbidity/mortality was assessed among the 6-months survivors.


RESULTS
A total of 423 patients overcame the first 6 months after the STEMI episode, of whom 370 (87%) underwent reperfusion therapy (363, 98% of them, with primary angioplasty). At 1-year follow-up, only 263 (62%) had adequate blood pressure control, 123 (29%) had LDL-cholesterol within targeted levels, 126/210 (60%) smokers had withdrawn from their habit and 40/112 (36%) diabetic patients had adequate glycosylated hemoglobin levels. During a median follow-up of 20 (11-30) months, cumulative mortality of 6 month-survivors was 6.1%, with 9.9% of hospital cardiovascular readmissions. The lack of assessment of LDL and HDL-cholesterol were significantly associated with higher mortality and cardiovascular readmission rates.


CONCLUSIONS
Whereas implementation of the AMI code resulted in a widespread access to rapid reperfusion therapy, its long-term therapeutic benefit may be partially counterbalanced by a manifestly suboptimal control of cardiovascular risk factors. Further efforts should be devoted to secondary prevention strategies after STEMI.
Cardiology Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain. 60055@hospitaldelmar.cat.|Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain. 60055@hospitaldelmar.cat.|Medicine Department, Program in Internal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain. 60055@hospitaldelmar.cat.
Núria
N
Ribas
Cardiology Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain.|Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
Cosme
C
García-García
Cardiology Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain.|Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
Oona
O
Meroño
Cardiology Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain.|Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
Lluís
L
Recasens
IMIM (Hospital del Mar Medical Research Institute). Cardiovascular Epidemiology and Genetics Group (EGEC), REGICOR Study Group, Barcelona, Spain.|CIBER de Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain.
Silvia
S
Pérez-Fernández
Cardiology Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain.
Víctor
V
Bazán
Cardiology Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain.|Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
Neus
N
Salvatella
Cardiology Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain.|Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
Julio
J
Martí-Almor
Cardiology Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain.|Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
Jordi
J
Bruguera
IMIM (Hospital del Mar Medical Research Institute). Cardiovascular Epidemiology and Genetics Group (EGEC), REGICOR Study Group, Barcelona, Spain.|CIBER de Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain.
Roberto
R
Elosua
D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D019033:Delivery of Health Care, Integrated; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D015397:Program Evaluation; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D055502:Secondary Prevention / Q000379:methods*; D012907:Smoking / Q000009:adverse effects; D016540:Smoking Cessation; D000074606:Smoking Prevention; D013997:Time Factors; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents
Cardiovascular risk factors; Coronary angioplasty; Prognosis; Reperfusion therapy; ST-segment elevation myocardial infarction; Secondary prevention