Prognosis of patients with a recurrent acute myocardial infarction before and in the reperfusion era - A national study

Background Patients with recurrent acute myocardial infarction (AMI) are at increased risk for morbidity and mortality. We compared the outcome of pat ients with recurrent AMI hospitalized in coronary care units in the prerepe rfusion and reperfusion eras. Methods The study population comprised 2 large-scale cohorts with recurrent AMI: (1) 1415 (24%) of 5839 consecutive patients with AMI hospitalized in 1981 to 1983 (Secondary Prevention Reinfarction Israeli Nifedipine Trial [S PRINT] Registry) and (2) 1093 (25%) of 4317 patients with AMI From three na tional surveys performed in 1992 to 1996. Results Patients in the 1990s hod significantly lower roles of heart failur e and cardiogenic shock. The 7-day mortality declined From 18% in 1981-1983 to 10% in 1992-1996 (adjusted odds ratio [OR] 0.57 [0.44-0.75]), the 30-da y mortality rate from 26% to 16% (OR 0.56 [0.44-0.71]), and the I-year mort ality rate from 39% to 26% (adjusted hazard ratio [HR] 0.64 [0.54-0.75]), r espectively. In the 1992-1996 cohort, the adjusted risk of 7-day, 30-day, a nd I-year mortality for patients with recurrent AMI treated with thrombolys is in comparison to patients without thrombolysis was OR 1.69 (1.07-2.65), 1.51 (1.03-2.23), and HR 1.18 (0.90-1.55), respectively. The mortality rate among patients treated with early percutaneous transluminal coronary angio plasty/coronary artery bypass grafting was 3% versus 12% at 7 days (OR 0.36 [0.16-0.73]), 7% versus 18% at 30 days (OR 0.45 [0.25-0.77]), and 16% vers us 29% at 1 year (HR 0.64 [0.46-0.96]), in comparison to patients without r evascularization. Conclusion: The prognosis of patients with recurrent AMI improved significa ntly during the reperfusion era. Although thrombolysis may have a limited t herapeutic effect among patients with recurrent AMI, an interventional appr oach seems more appropriate when indicated. A randomized trial of thromboly sis versus early revascularization is needed in patients with recurrent AMI .