Predictors of recurrent acute myocardial infarction despite successful percutaneous coronary intervention

Abstract

Background/Aims: Recurrent acute myocardial infarction (AMI) is an adverse cardiac event in patients with a first AMI. The predictors of recurrent AMI after the first AMI in patients who underwent successful percutaneous coronary intervention (PCI) have not been elucidated.Methods: We analyzed the data collected from 9,869 patients (63.2 ± 12.4 years, men:women = 7,446:2,423) who were enrolled in the Korea Acute Myocardial Infarction Registry-National Institute of Health between November 2011 and October 2015, had suffered their first AMI and had received successful PCI during the index hospitalization. Multivariable logistic regression analysis was performed to identify the independent predictors of recurrent AMI following the first AMI.Results: The cumulative incidence of recurrent AMI after successful PCI was 3.6% (359/9,869). According to the multivariable logistic regression analysis, the significant predictive factors for recurrent AMI were diabetes mellitus, renal dysfunction, atypical chest pain, and multivessel disease.Conclusions: In this Korean prospective cohort study, the independent predictors of recurrent AMI after successful PCI for the first AMI were diabetes mellitus, renal dysfunction, atypical chest pain, and multivessel disease.

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“…Percutaneous coronary intervention (PCI) is an efficacious treatment option for AMI, and its application has improved the prognosis of AMI patients to a certain extent [ 3 ]. Unfortunately, disease recurrence and other major adverse cardiovascular events (MACE) would also happen in AMI patients even after successful PCI [ 4 – 6 ]. It is estimated that the incidence of recurrent AMI after PCI within 3 years ranges from 3.6 to 6.9% [ 4 , 7 ], and the incidence of MACE after PCI within 2 years ranges from 9.7 to 16.5% [ 8 – 10 ].…”

Predictors of recurrent acute myocardial infarction despite initially successful percutaneous coronary intervention: back to the basic

“…Another prospective cohort study (the ST segment elevation myocardial infarction [STEMI] study) enrolled MI patients treated via primary PCI; the 3-year incidence of re-MI was 6.9% [2]. The risk factors for recurrent ischemic events are both clinical (age, diabetes mellitus, prior MI, stroke, unstable angina, heart failure, the extent of coronary artery dissection, and the use of revascularization to treat the index event) and biochemical (the levels of high-sensitivity troponins, C-reactive protein, N-terminal pro-B-type natriuretic peptide, and growth differentiation factor-15) [3][4][5][6].…”

“…In this issue of the Korean Journal of Internal Medicine , Lee et al [ 6 ] report a re-MI rate of 3.6% in patients for whom the initial AMI had been successfully treated via PCI; factors significantly predictive of re-AMI were diabetes mellitus, renal dysfunction, atypical chest pain, and multi-vessel disease [ 7 ]. After exclusion of prior MI at the time of the index event, 10,759 patients who underwent successful PCI (only) were clinically followed-up in terms of re-MI by the Korea Acute Myocardial Infarction Registry (KAMIR)-National Institute of Health (NIH).…”

“…What is the major risk factor for the development of re-MI? Lee et al [ 6 ] did not explore laboratory markers such as the lipid profile, the appropriateness of clinical control of diabetes and hypertension, or lesional characteristics (the precise re-MI location or stent details [type, number, or length]) because the data were limited. One re-MI trial enrolling patients with similar clinical characteristics and risk factors indicated that inappropriate guideline-directed medical treatment (GDMT) may play a role in re-MI development [ 8 ].…”

“…Lee et al [ 6 ] found that re-MI was significantly associated with diabetes mellitus, renal dysfunction, atypical chest pain, and multi-vessel disease; of these, all except chest pain are well known predictors of re-MI [ 9 ]. Notably, atypical chest pain was a statistically significant predictor of re-MI (odds ratio, 1.495; 95% confidence interval, 1.12.5 to 1.987; p = 0.006).…”