Risk for early ischemic event after acute myocardial infarction in working males

Abstract

We attempt to predict ischemic events in the weeks following the hospital discharge after acute myocardial infarction (AMI) in order to aid occupational physicians in taking return-to-work decisions. Included in the study were 1299 AMI patients from 14 coronary care units in Israel who had been employed before hospitalization and were seen after discharge 1, 2, 4, 6, 9 and 12 months after the first AMI. Cardiovascular accidents included death from cardiovascular disease, recurrent infarction or hospitalization due to congestive heart failure or unstable angina. The rate of a first recurrent cardiovascular accident decreased rapidly over the first few weeks. The risk in the third week was still 51 per 1000 person-months, 13.4 (95% CI: 9.2-19.5) times higher than that after 10 weeks when the incidence reached a low steady state. The major predictors in a logistic regression model for an event were: older age, past history of a cerebrovascular event, and congestive heart failure during the course of hospitalization, but the area under the receiver-operator curve was only 64.4%. We conclude that after acute myocardial infarction, the major risk for a recurrent event is a lapse of time from discharge but not other clinical variables. This should be taken into account when considering a proper timing of return-to-work after an acute myocardial infarction.