Two-year outcomes among stable high-risk patients following acute MI. Insights from a global registry in 25 countries

David Brieger, Stuart J. Pocock, Stefan Blankenberg, Ji Yan Chen, Mauricio G. Cohen, Christopher B. Granger, Richard Grieve, Jose C. Nicolau, Tabassome Simon, Dirk Westermann, Satoshi Yasuda, John Gregson, Kirsten L. Rennie, Katarina Hedman, Karolina Andersson Sundell, Shaun G. Goodman

Research output: Contribution to journalArticle

Abstract

Background: Evidence is lacking on long-term outcomes in unselected patients surviving the first year following myocardial infarction (MI). Methods and results: The TIGRIS (long-Term rIsk, clinical manaGement and healthcare Resource utilization of stable coronary artery dISease in post-myocardial infarction patients) prospective registry enrolled 9176 eligible patients aged ≥50 years, 1–3 years post-MI, from 25 countries. All had ≥1 risk factor: age ≥ 65 years, diabetes mellitus, second prior MI, multivessel coronary artery disease, chronic kidney disease (CKD). Primary outcome was a composite of MI, unstable angina with urgent revascularization, stroke, or all-cause death at 2-year follow-up. Bleeding requiring hospitalization was also recorded. 9027 patients (98.4%) provided follow-up data: the primary outcome occurred in 621 (7.0%), all-cause mortality in 295 (3.3%), and bleeding in 109 (1.2%) patients. Events accrued linearly over time. In multivariable analyses, qualifying risk factors were associated with increased risk of primary outcome (incidence rate ratio [RR] per 100 patient-years [95% confidence interval]): CKD 2.06 (1.66, 2.55), second prior MI 1.71 (1.38, 2.10), diabetes mellitus 1.63 (1.39, 1.92), age ≥ 65 years 1.53 (1.28, 1.83), and multivessel disease 1.24 (1.05, 1.48). Risk of bleeding events was greater in older patients (vs <65 years) 65–74 years 2.68 (1.53, 4.70), ≥75 years 4.62 (2.57, 8.28), and those with CKD 1.99 (1.18, 3.35). Conclusion: In stable patients recruited 1–3 years post-MI, recurrent cardiovascular and bleeding events accrued linearly over 2 years. Factors independently predictive of ischemic and bleeding events were identified, providing a context for deciding on treatment options.

Original languageEnglish (US)
JournalInternational Journal of Cardiology
DOIs
StateAccepted/In press - Jan 1 2020
Externally publishedYes

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Keywords

  • Myocardial infarction
  • Observational
  • Stable coronary artery disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Brieger, D., Pocock, S. J., Blankenberg, S., Chen, J. Y., Cohen, M. G., Granger, C. B., Grieve, R., Nicolau, J. C., Simon, T., Westermann, D., Yasuda, S., Gregson, J., Rennie, K. L., Hedman, K., Sundell, K. A., & Goodman, S. G. (Accepted/In press). Two-year outcomes among stable high-risk patients following acute MI. Insights from a global registry in 25 countries. International Journal of Cardiology. https://doi.org/10.1016/j.ijcard.2020.01.070