American heart journal · 2026
Clinical outcomes associated with recurrent compared to first-time myocardial infarction.
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Christensen Daniel Mølager, Garred Caroline Hartwell, Malmborg Morten, Sindet-Pedersen Caroline, Zahir Deewa, Nouhravesh Nina, Fosbøl Emil, Docherty Kieran F, Butt Jawad H, McMurray John J V, Petrie Mark C, Pfeffer Marc A, Køber Lars, Schou Morten
Аннотация
BACKGROUND: Patients with recurrent myocardial infarction (MI) are a heterogenous group with high comorbidity burden, risk of complex coronary disease, and at risk of poor outcomes. However, contemporary comparative data are lacking.
METHODS: Consecutive patients with recurrent MI (defined as a new hospital admission for MI > 28 days following a first-time MI) in Denmark between 2015 and 2022 were identified through the nationwide registries and matched 1:1 on age and sex to patients with first-time MI. The primary outcome was a composite of all-cause mortality, hospitalization for heart failure (HHF), and further recurrent MI. Standardized risks with 95% confidence intervals (CI) were estimated using cause-specific Cox regression models with first-time MI serving as the reference group.
RESULTS: A total of 8,397 patients with recurrent MI and 8,397 with first-time MI were included (median age 73, 70.7% male). Patients with recurrent MI had more comorbidities. For the primary composite outcome, patients with recurrent MI had a standardized 1-year risk of 24.0% vs 17.2% among those with first MI (standardized risk ratio [sRR] 1.39 [95% CI: 1.34-1.44]). They also had higher risks of: all-cause mortality, 14.6% vs 11.3% (sRR 1.29 [1.24-1.35]); HHF, 6.6% vs 6.0% (sRR 1.11 [1.00-1.21]), and recurrent MI 6.7% vs 2.2% (sRR 3.01 [2.71-3.45]). Use of guideline-recommended treatments postdicharge was high, albeit lower than for first-time MI: percutaneous coronary intervention (53.7% vs 64.3%, P < .001), lipid-lowering treatment (78.1% vs 83.2%, P < .001), and P2Y12 inhibitor (77.3% vs 82.6%, P < .001).
CONCLUSION: Recurrent MI is associated with a higher risk of all-cause mortality, HHF, and further recurrent MI compared with first-time MI.
METHODS: Consecutive patients with recurrent MI (defined as a new hospital admission for MI > 28 days following a first-time MI) in Denmark between 2015 and 2022 were identified through the nationwide registries and matched 1:1 on age and sex to patients with first-time MI. The primary outcome was a composite of all-cause mortality, hospitalization for heart failure (HHF), and further recurrent MI. Standardized risks with 95% confidence intervals (CI) were estimated using cause-specific Cox regression models with first-time MI serving as the reference group.
RESULTS: A total of 8,397 patients with recurrent MI and 8,397 with first-time MI were included (median age 73, 70.7% male). Patients with recurrent MI had more comorbidities. For the primary composite outcome, patients with recurrent MI had a standardized 1-year risk of 24.0% vs 17.2% among those with first MI (standardized risk ratio [sRR] 1.39 [95% CI: 1.34-1.44]). They also had higher risks of: all-cause mortality, 14.6% vs 11.3% (sRR 1.29 [1.24-1.35]); HHF, 6.6% vs 6.0% (sRR 1.11 [1.00-1.21]), and recurrent MI 6.7% vs 2.2% (sRR 3.01 [2.71-3.45]). Use of guideline-recommended treatments postdicharge was high, albeit lower than for first-time MI: percutaneous coronary intervention (53.7% vs 64.3%, P < .001), lipid-lowering treatment (78.1% vs 83.2%, P < .001), and P2Y12 inhibitor (77.3% vs 82.6%, P < .001).
CONCLUSION: Recurrent MI is associated with a higher risk of all-cause mortality, HHF, and further recurrent MI compared with first-time MI.