Cardiovascular risk in post-myocardial infarction patients: nationwide real world data demonstrate the importance of a long-term perspective

• Published in: European heart journal Vol. 36; no. 19; pp. 1163 - 1170
• Main Authors: Jernberg, Tomas, Hasvold, Pål, Henriksson, Martin, Hjelm, Hans, Thuresson, Marcus, Janzon, Magnus
• Format: Journal Article
• Language: English
• Published: England 14.05.2015
• Subjects: Adult; Aged; Aged, 80 and over; Cardiovascular Diseases - mortality; Disease Progression; Epidemiologic Methods; Female; Hospitalization - statistics & numerical data; Humans; Kaplan-Meier Estimate; Male; Medicin och hälsovetenskap; Middle Aged; Myocardial Infarction - mortality; Stroke - mortality; Sweden - epidemiology; Sweden; Myocardial infarction; Prognosis; Nationwide register data; Mortality; Risk factors
• ISSN: 0195-668X; 1522-9645; 1522-9645
• DOI: 10.1093/eurheartj/ehu505

Long-term disease progression following myocardial infarction (MI) is not well understood. We examined the risk of subsequent cardiovascular events in patients discharged after MI in Sweden. This was a retrospective, cohort study linking morbidity, mortality, and medication data from Swedish national registries. Of 108 315 patients admitted to hospital with a primary MI between 1 July 2006 and 30 June 2011 (index MI), 97 254 (89.8%) were alive 1 week after discharge and included in this study. The primary composite endpoint of risk for non-fatal MI, non-fatal stroke, or cardiovascular death was estimated for the first 365 days post-index MI and Day 366 to study completion. Risk and risk factors were assessed by Kaplan-Meier analysis and Cox proportional hazards modelling, respectively. Composite endpoint risk was 18.3% during the first 365 days post-index MI. Age [60-69 vs. <60 years: HR (95% CI): 1.37 (1.30-1.45); 70-79 vs. <60 years: 2.13 (2.03-2.24); >80 vs. <60 years: 3.96 (3.78-4.15)], prior MI [1.44 (1.40-1.49)], stroke [1.49 (1.44-1.54)], diabetes [1.37 (1.34-1.40)], heart failure [1.57 (1.53-1.62)] and no index MI revascularisation [1.88 (1.83-1.93)] were each independently associated with a higher risk of ischaemic events or death. For patients without a combined endpoint event during the first 365 days, composite endpoint risk was 20.0% in the following 36 months. Risk of cardiovascular events appeared high beyond the first year post-MI, indicating a need for prolonged surveillance, particularly in patients with additional risk factors.