Recurrent Myocardial Infarction After Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction

• Published in: The American journal of cardiology Vol. 113; no. 2; pp. 229 - 235
• Main Authors: Kikkert, Wouter J., MD, Hoebers, Loes P., MD, Damman, Peter, MD, PhD, Lieve, Krystien V.V, Claessen, Bimmer E.P.M., MD, PhD, Vis, Marije M., MD, PhD, Baan, Jan, MD, PhD, Koch, Karel T., MD, PhD, de Winter, Robbert J., MD, PhD, Piek, Jan J., MD, PhD, Tijssen, Jan G.P., PhD, Henriques, Jose P.S., MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.01.2014; Elsevier Limited
• Subjects: Aged; Cardiology; Cardiovascular; Cause of Death - trends; Coronary vessels; Electrocardiography; Female; Follow-Up Studies; Heart attacks; Humans; Incidence; Kaplan-Meier Estimate; Male; Middle Aged; Mortality; Myocardial Infarction - epidemiology; Myocardial Infarction - physiopathology; Myocardial Infarction - surgery; Netherlands - epidemiology; Percutaneous Coronary Intervention - methods; Prognosis; Recurrence; Retrospective Studies; Risk Assessment - methods; Risk Factors; Stents; Survival Rate - trends; Time Factors; Netherlands
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2013.08.039

The determinants and prognostic value of recurrent myocardial infarction (MI) in a contemporary cohort of ST-segment elevation MI patients treated with primary percutaneous coronary intervention (PPCI) and stenting are currently unknown. We investigated the predictors and prognostic impact of recurrent MI on subsequent clinical outcome in 1,700 ST-segment elevation MI patients treated with PPCI and stenting between January 1, 2003, and July 31, 2008. Two hundred forty patients had a recurrent MI during a median follow-up of 4 years and 7 months (Kaplan Meier estimate 21.2%). By multivariable analysis, recurrent MI was associated with a higher risk of subsequent cardiac mortality (hazard ratio [HR] 6.86, 95% confidence interval [CI] 4.24 to 8.72), noncardiac mortality (HR 2.02, 95% CI 1.10 to 3.69), stroke (HR 3.68, 95% CI 2.02 to 6.72), and Global Use of Strategies to Open Occluded Coronary Arteries criteria severe or moderate bleeding (HR 3.17, 95% CI 1.79 to 5.60). Early recurrent MI (within 1 day of the initial PPCI) was associated with higher unadjusted cardiac mortality rates (64.4%) compared with recurrent MIs occurring ≥1 day after PPCI. However, after multivariable adjustment, late recurrent MI (occurring >1 year after PPCI) was associated with the highest risk of subsequent cardiac mortality (HR 7.98, 95% CI 5.05 to 12.6). The risk of cardiac death was irrespective of the presence of persistent ST-segment elevation during the recurrent MI. In conclusion, recurrent MI after PPCI remains a relatively common complication in contemporary practice and confers a significantly increased risk of death, stroke, and bleeding.