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ȣ - 530641 20 |
The Influence of Prior Myocardial Infarction on 12-month Clinical Outcomes in Patients with Acute Non-ST-Segment Elevation Myocardial Infarction |
고려대학교 구로병원 순환기내과¹ ,전남대학교병원 순환기내과² |
나승운, Lin Wang¹, 박지영¹, Kanhaiya L. Poddar¹, Lin Wang¹, 최병걸¹, 김지박¹, 신승용¹, 최운정¹, 최철웅¹, 임홍의¹, 김진원¹, 김응주¹, 박창규¹, 서홍석¹, 오동주¹, 정명호², 안영근² |
Background: There are very limited data regarding the influences of previous myocardial infarction (MI) on the outcomes of recurrent acute non-ST-segment elevation MI (re-NSTEMI) patients (pts), especially after primary percutaneous coronary intervention (PCI) in DES era.
Method: The current data came from the Korea Acute Myocardial Infarction Registry (KAMIR) study, which consisted of 4121 consecutive acute NSTEMI pts enrolled from November 2005 to April 2008. Among them, 492 (11.94%) pts presented with recurrent AMI (NSTEMI) with previous history of MI. We compared the clinical outcomes of re-AMI pts presented as NSTEMI with those of first-onset NSTEMI (first-AMI group, n=3629) at 12 months.
Results: The baseline characteristics are largely unfavorable in re-MI group over first-AMI group. At 12 months, although the incidence of repeat PCI were similar between the groups, the mortality, recurrent AMI (primarily due to increased NSTEMI), and major adverse cardiac events (MACE) were higher in the re-AMI group compared with those of first-AMI group (Table). Previous MI was an independent predictor of MACE at 12 months in re-AMI group (ORunadjusted:1.771, 95% CI: 1.378-2.276, P<0.001) even after adjusted of many confounding variables (ORadjusted:1.503, 95% CI: 1.084-2.086, P=0.015).
Conclusion: Acute NSTEMI pts with previous MI presented with worse baseline clinical and procedural characteristics and more associated with worse major clinical outcomes up to 12 months compared with those of first onset NSTEMI pts.
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Table. Clinical Outcomes at 12-month
Variables, N (%) |
Re-AMI
(N=492) |
First-AMI
(N=3629) |
P-values |
Total Death |
38 (5.17) |
121 (3.3) |
<0.001 |
Cardiac Death |
27 (5.5) |
80 (2.2) |
0.001 |
TLR |
9 (1.8) |
60 (1.7) |
0.775 |
TVR |
10 (2.0) |
84 (2.3) |
0.694 |
Non-TVR |
11 (2.2) |
67 (1.8) |
0.552 |
Recurrent AMI |
16 (3.3) |
42 (1.2) |
<0.001 |
STEMI |
2 (0.4) |
9 (0.2) |
0.523 |
NSTEMI |
14 (2.8) |
33 (0.9) |
<0.001 |
CABG |
3 (0.6) |
17 (0.5) |
0.672 |
Total MACE |
75 (15.2) |
326 (9.0) |
<0.001 |
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