Long-term outcomes of the Coordinated Care Program in Patients after Myocardial Infarction (KOS-MI).

BACKGROUND

The Coordinated Care in Myocardial Infarction Program (KOS-MI) was introduced to improve prognosis for patients after myocardial infarction (MI). The program includes complete revascularization followed by unrestricted access to rehabilitation, electrotherapy, and cardiac care.

AIM: This study aimed to assess major adverse cardiac and cerebrovascular events (MACCE) of patients enrolled in the KOS-MI at 3-year follow-up.

METHODS

This is a retrospective, multicenter registry of patients treated for MI. The study group (KOS-MI) of 963 patients was compared to the control group (standard care) of 1009 patients. At 3-year follow-up, MACCE including death, MI, stroke, and repeated revascularization were reported. Additionally, hospitalization for heart failure (HF) was analyzed. Propensity score matching (PSM) was utilized for group baseline characteristic adjustment.

RESULTS

Patients in the KOS-MI group were younger (65 vs. 68 years; P <0.001), mostly men (70% vs. 62.9%; P <0.001), admitted with ST-segment elevation myocardial infarction (STEMI) (44.6% vs. 36.2%; P <0.001). Patients in the control group had more comorbidities and were admitted more often with non-ST-segment elevation myocardial infarction (63.8% vs. 55.4%; P <0.001) and acute HF (5.1% vs. 2.7%; P = 0.007). Following PSM, 530 well matched pairs were selected. At three years (92.3% follow-up completeness), the relative risk reduction was: 25% in MACCE (P = 0.008), 38% in mortality (P = 0.008), 29% in repeated revascularization (P = 0.04), and 28% (P = 0.0496) in hospitalization for HF in the KOS-MI group.

CONCLUSIONS

The combination of contemporary invasive techniques, complete revascularization, cardiac rehabilitation, and ambulatory care included in the KOS-MI Program improves long-term prognosis of patients after MI in 3-year follow-up.