Cleveland Clinic Heart, Vascular and Thoracic Institute Cleveland OH.
Cleveland Clinic Heart, Vascular and Thoracic Institute Center for Healthcare Delivery Innovation Cleveland OH.
J Am Heart Assoc. 2021 Aug 17;10(16):e019270. doi: 10.1161/JAHA.120.019270. Epub 2021 Aug 2.
Background We aimed to understand the characteristics and outcomes of patients readmitted with a recurrent myocardial infarction (RMI) within 90 days of discharge after an acute myocardial infarction (early RMI). Methods and Results We analyzed the timing of reinfarction, etiology, and outcome for all patients admitted with an early RMI within 90 days of discharge after an acute myocardial infarction between January 1, 2010 and January 1, 2017. We identified 6626 admissions for acute myocardial infarction (index myocardial infarction) which led to 168 cases of RMI within 90 days of discharge. The mean patient age was 65.1±13.1 years, and 37% were women. The 90-day probability of readmission with an early RMI was 2.5%. Black race, medical management, higher troponin T, and shorter length of stay were independent predictors of early RMI. Medically managed group had a higher risk for early RMI compared with percutaneous coronary intervention (=0.04) or coronary artery bypass grafting (=0.2). Predominant mechanisms for reinfarction were stent thrombosis (17%), disease progression (12%), and unchanged coronary artery disease (11%). At 5 years, the all-cause mortality rate for patients with an early RMI was 49% (95% CI, 40%-57%) compared with 22% (95% CI, 21%-23%) for patients without an early RMI (<0.0001). Conclusions Early RMI is a life-threatening condition with nearly 50% mortality within 5 years. Stent-related events and progression in coronary artery disease account for most early RMI. Medication compliance, aggressive risk factor management, and care transitions should be the cornerstone in preventing early RMI.
背景 我们旨在了解急性心肌梗死（AMI）后 90 天内因复发性心肌梗死（RMI）再入院患者的特征和结局。 方法和结果 我们分析了 2010 年 1 月 1 日至 2017 年 1 月 1 日期间所有在 AMI 后 90 天内因 RMI 再入院患者的再梗死时间、病因和结局。我们确定了 6626 例 AMI 住院患者（索引性心肌梗死），其中有 168 例在出院后 90 天内发生 RMI。患者平均年龄为 65.1±13.1 岁，37%为女性。90 天内因早期 RMI 再入院的概率为 2.5%。黑种人、药物治疗、较高的肌钙蛋白 T 和较短的住院时间是早期 RMI 的独立预测因素。与经皮冠状动脉介入治疗（=0.04）或冠状动脉旁路移植术（=0.2）相比，药物治疗组发生早期 RMI 的风险更高。再梗死的主要机制是支架血栓形成（17%）、疾病进展（12%）和不变的冠状动脉疾病（11%）。在 5 年内，早期 RMI 患者的全因死亡率为 49%（95%CI，40%-57%），而无早期 RMI 患者的死亡率为 22%（95%CI，21%-23%）（<0.0001）。 结论 早期 RMI 是一种危及生命的疾病，5 年内死亡率接近 50%。支架相关事件和冠状动脉疾病进展是导致早期 RMI 的主要原因。药物依从性、积极的危险因素管理和医疗过渡期应成为预防早期 RMI 的基石。
