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Predictors and prognostic impact of recurrent myocardial infarction in patients with left ventricular dysfunction, heart failure, or both following a first myocardial infarction
Author(s) -
Thune Jens Jakob,
Signorovitch James E.,
Kober Lars,
McMurray John J.V.,
Swedberg Karl,
Rouleau Jean,
Maggioni Aldo,
Velazquez Eric,
Califf Robert,
Pfeffer Marc A.,
Solomon Scott D.
Publication year - 2011
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hfq194
Subject(s) - medicine , myocardial infarction , cardiology , heart failure , context (archaeology) , unstable angina , valsartan , angina , cohort , hazard ratio , confidence interval , blood pressure , paleontology , biology
Aims Recurrent myocardial infarction (MI) is common after a first MI and is associated with increased morbidity and mortality. Predictors and prognosis of a recurrent MI with contemporary management are not well known. Methods and results We assessed the predictors and prognostic impact of a first recurrent MI in 10 599 patients with left ventricular dysfunction, heart failure, or both following a first MI from the Valsartan in Acute Myocardial Infarction Trial (VALIANT) cohort. During a median follow‐up of 27.4 months, 861 patients (9.6%) had a recurrent MI. The median time to recurrence was 136 days (quartiles 35–361 days), with a declining rate of recurrent MI within the first 3 months. The strongest predictors of recurrent MI were reduced estimated glomerular filtration rate, unstable angina, diabetes, and age. Mortality was markedly elevated (20.5%) within the first 7 days of a recurrent MI. Patients who survived 7 days after a recurrent MI continued to be at increased risk of death compared with patients without a recurrent MI and the risk of death remained elevated more than two‐fold a year after the recurrent MI (adjusted hazards ratio 2.4, 95% confidence interval 1.7–3.2). One‐year mortality for the entire VALIANT cohort was 10.3%, whereas 38.3% of the patients were dead 1 year after recurrent MI. Early reinfarctions (within 1 month) was associated with significantly higher 30‐day mortality than later reinfarctions. Conclusion Even in the context of contemporary treatment, a recurrent MI confers a significantly increased risk of death in patients following a high‐risk first MI. Strategies aimed at reducing recurrent MI will thus likely prolong survival in post‐MI survivors.