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Observational Study
. 2019 Mar 28;19(1):71.
doi: 10.1186/s12872-019-1062-y.

Unsatisfactory risk factor control and high rate of new cardiovascular events in patients with myocardial infarction and prior coronary artery disease

Jarle Jortveit  1 , Sigrun Halvorsen  2 , Anete Kaldal  3 , Are Hugo Pripp  4 , Ragna Elise S Govatsmark  5 , Jørund Langørgen  6
Affiliations
Observational Study

Unsatisfactory risk factor control and high rate of new cardiovascular events in patients with myocardial infarction and prior coronary artery disease

Jarle Jortveit et al. BMC Cardiovasc Disord. .

Abstract

Background: Patients with established coronary artery disease (CAD) have an increased risk of new cardiovascular events. An underuse of secondary preventive drugs has been observed, and many patients may not attain the treatment goals for secondary prevention. The aims of the present nationwide register-based cohort study were to assess the degree of risk factor control and long-term outcomes in patients < 80 years with Type 1 myocardial infarction (MI) with and without prior CAD.

Methods: Data concerning all patients with MI admitted to hospitals in Norway from 2013 to 2016 were retrieved from the Norwegian Myocardial Infarction Register (NORMI). Long-term mortality was obtained through linkage with the Norwegian Cause of Death Registry.

Results: In total, 47,204 patients were registered in the NORMI from 2013 to 2016. Prior CAD was recorded in 7219 (25.2%) of the 28,607 patients < 80 years old with Type 1 MIs. On average, 3 of the 6 defined treatment targets for secondary preventive therapy were attained, and only 1% of the patients achieved all targets. Patients with MI and prior CAD had increased risk of death or new MI compared to patients without prior CAD during long-term follow-up (adjusted HR 1.6, 95% CI 1.5-1.7).

Conclusions: Prior CAD was frequent in patients with acute MI. The attainment of secondary preventive treatment targets in patients with MI and prior CAD was not optimal, and the long-term outcomes were reduced compared to patients without prior CAD. Increased efforts to improve risk factor control are needed.

Keywords: Myocardial infarction; Risk factors; Secondary prevention.

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Conflict of interest statement

Ethics approval and consent to participate

The Regional Committee for Medical and Health Research Ethics approved the study (REK 2016/170). No consent to participate was required.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Patients admitted to hospitals in Norway with myocardial infarction from 2013 to 2016
Fig. 2
Fig. 2
Risk factor control in patients < 80 years with coronary artery disease hospitalized with Type 1 myocardial infarction in Norway from 2013 to 2016 (n = 7219) (Patients with missing data were excluded)
Fig. 3
Fig. 3
The numbers of secondary preventive treatment targets* attained in patients < 80 years hospitalized with Type 1 myocardial infarction and having prior coronary artery disease in Norway from 2013 to 2016 (n = 7219) (No smoking, blood pressure < 149/90 mmHg, LDL cholesterol < 1.8 mmol/L, body mass index < 25 kg/m2, acetylsalicylic acid and statin use.) (Missing information was counted as “not attained”)
Fig. 4
Fig. 4
a Death or recurrent myocardial infarction during long-term follow-up in patients < 80 years with Type 1 myocardial infarction, with and without prior coronary artery disease in Norway from 2013 to 2016. b Cumulative survival following Type 1 myocardial infarction in patients < 80 years with and without prior coronary artery disease in Norway from 2013 to 2016
See this image and copyright information in PMC

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