Long-term prognosis of patients with acute myocardial infarction in the era of acute revascularization (from the Heart Institute of Japan Acute Myocardial Infarction [HIJAMI] registry).

BACKGROUND

The long-term prognosis of patients with acute myocardial infarction (AMI) in the contemporary acute revascularization era is not fully understood.

METHODS

To clarify long-term prognosis and prognostic factors of AMI patients in a real-world setting, we consecutively registered 3021 patients with AMI (mean age 69 years, 70.7% male) who were admitted to 17 participating medical institutions and followed up prospectively. The outcome measure was death from any cause.

RESULTS

Among 3021 patients, 629 patients had non-ST elevation MI (non-STEMI). During the index hospitalization, coronary angioplasty and thrombolytic therapy were performed in 58.1% and 16.3% of patients, respectively. During hospitalization, 285 patients (9.4%) died. Among 2736 patients (90.6%) who were discharged alive and followed for a median of 4.3 years (follow-up rate, 97.1%), 434 patients (15.9%) died. Among them, 250 (57.6%) died from non-cardiac causes. Compared with STEMI patients, non-STEMI patients suffered significantly more adverse outcomes. Advanced age and non-STEMI disease were associated with poorer outcomes. Multivariate analysis revealed that diabetes mellitus, acute-phase heart failure (Killip functional class ≥ 2), higher serum creatinine level (≥ 1.2 mg/dl), and advanced age (≥ 70 years and ≥ 80 years) at the onset of the AMI were independent poor prognostic factors (hazard ratios, 1.07, 2.53, 1.89, 2.50, and 6.80 respectively).

CONCLUSIONS

AMI patients in the era of acute revascularization have favorable long-term prognoses, and a large proportion of late deaths are non-cardiac in nature. The establishment of an optimal management strategy for elderly AMI patients, AMI patients with diabetes, and non-ST elevation AMI patients are essential.