Study of the course of recurrent myocardial infarction in the acute stage within the framework the hospital register

Aim. To study the features of the course of primary and recurrent myocardial infarction and compare their prognosis in the acute stage of the disease within the framework of the hospital register of the vascular center.

Material and methods. The data from the acute coronary syndrome register of N. V. Sklifosovsky Research Institute for Emergency Medicine were used. The inclusion criteria were: transmural acute myocardial infarction (AMI) with ST-segment elevation (codes I21.0-I21.3 according to the International Classification of Diseases); permanent residence in Moscow and the Moscow region. The described part of the study included all patients with transmural myocardial infarction (codes I21.0-I.21.3) admitted from January 1, 2017 to December 31, 2017. Of the AMI patients admitted during this period (n=329), 214 met the inclusion criteria, with primary AMI in 153 and recurrent AMI in 61.

Results. Patients with recurrent AMI were significantly older, more often had a disability group. Smoking and arterial hypertension were more frequent risk factors among patients with recurrent AMI than in primary AMI. All indices reflecting the severity of coronary artery disease and its complications were also significantly more common in the group with recurrent AMI. Diabetes mellitus was more common in these patients. Taking medications before hospitalization, as well as the regularity of this intake, were significantly more common in patients who had repeated AMI. The mortality rate of patients with recurrent AMI was 4.6 times higher than that of patients with primary AMI. Such complications as atrial fibrillation and flutter, intracardiac conduction disturbance requiring temporary endocardial stimulator placement, acute heart failure requiring intra-aortic balloon counterpulsation, respiratory failure requiring artificial ventilation, cardiogenic shock were significantly more common in patients with recurrent AMI. Kaplan-Meyer curves clearly demonstrate the differences in hospital mortality among the two groups of patients. These curves also clearly show that patients with primary AMI died mostly in the first days of the disease, but patients with recurrent AMI could die at a much later date, up to 12 days after admission. Analysis of factors determining the mortality risk during hospitalization showed that recurrent AMI is an independent predictor of death.

Conclusion. The results of our work indicate the need for prompt identification of patients who had previously undergone AMI upon their admission to the vascular center, as well as the development of more active prevention tactics for such patients.

1. Radovanovic D, Maurer L, Bertel O, et al. Treatment and outcomes of patients with recurrent myocardial infarction: A prospective observational cohort study. J Cardiol. 2016;68(6):498-503. DOI:10.1016/j.jjcc.2015.11.013.

2. Samorodskaya IV, Boytsov SA. Subsequent myocardial infarction: risk assessment and prevention. Russ J Cardiol. 2017;6(146):139-45 (In Russ.) DOI:10.15829/1560-4071-2017-6-139-145.

3. Thygesen K, Alpert JS, Jaffe AS, et al; Executive Group on behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction. Fourth Universal Definition of Myocardial Infarction (2018). J Am Coll Cardiol. 2018;72(18):2231-64. DOI:10.1016/j.jacc.2018.08.1038.

4. National Clinical Coding Standards ICD-10 5th Edition (2023). Leeds, UK: NHS England; 2023.

5. Yu Т, Jiao Y, Song J, et al. Hospital mortality in acute coronary syndrome: adjustment of GRACE score by D-dimer enables a more accurate prediction in a prospective cohort study. BMC Cardiovasc Disord. 2019;19(1):252. DOI:10.1186/s12872-019-1239-4.

6. Roe MT, Parsons LS, Pollack CV Jr, et al.; National Registry of Myocardial Infarction Investigators. Quality of care by classification of myocardial infarction: treatment patterns for ST-segment elevation vs non-ST-segment elevation myocardial infarction. Arch Intern Med. 2005;165(14):1630-6. DOI:10.1001/archinte.165.14.1630.

7. Erlikh AD, Gratsiansky NA on behalf of participants RECORD-3 registers. Registry of acute coronary syndromes "RECORD-3". Characteristics of patients and treatment until discharge during initial hospitalization. Kardiologiia. 2016;56(4):16-24 (In Russ.) DOI:10.18565/cardio.2016.4.16-24.

8. Gridnev VI, Kiselev AR, Posnenkova OM, et al.; Russian Registry of Acute Coronary Syndrome Investigators. Objectives and Design of the Russian Acute Coronary Syndrome Registry (RusACSR). Clin Cardiol. 2016;39(1):1-8. DOI:10.1002/clc.22495.

9. Boytsov SA, Shakhnovich RM, Tereschenko SN, et al. The prevalence of hyperlipidemia and features of lipid-lowering therapy in patients with myocardial infarction according to the Russian register of acute myocardial infarction REGION-MI. Kardiologiia. 2022;62(7):12-22 (In Russ.) DOI:10.18087/cardio.2022.7.n2051.

10. Goldberg RJ, Currie K, White K, et al. Six-month outcomes in a multinational registry of patients hospitalized with an acute coronary syndrome (the Global Registry of Acute Coronary Events [GRACE]). Am J Cardiol. 2004;93(3):288-93. DOI:10.1016/j.amjcard.2003.10.006.

11. Eagle KA, Lim MJ, Dabbous OH, et al; GRACE Investigators. A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month postdischarge death in an international registry. JAMA. 2004;291(22):2727-33. DOI:10.1001/jama.291.22.2727.

12. Aragam KG, Tamhane UU, Kline-Rogers E, et al. Does simplicity compromise accuracy in ACS risk prediction? A retrospective analysis of the TIMI and GRACE risk scores. PLoS One. 2009;4(11):e7947. DOI:10.1371/journal.pone.0007947.

13. Kim HK, Jeong MH, Lee SH, et al. The scientific achievements of the decades in Korean Acute Myocardial Infarction Registry. Korean J Intern Med. 2014;29(6):703-12. DOI:10.3904/kjim.2014.29.6.703.

14. Martsevich SY, Kutishenko NP, Ginzburg ML, et al. LIS Study (Lyubertsy Study of mortality in patients after acute myocardial infarction): the patients’ portrait. Cardiovascular Therapy and Prevention. 2011;10(6):89-93 (In Russ.) DOI:10.15829/1728-8800-2011-6-89-93.