Predictors and impact of in-hospital recurrent myocardial infarction in acute coronary syndrome patients: Findings from Gulf RACE-2

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• 作者：A. Al-Saleh ; A. Hersi ; K.F. Alhabib ; A.A. Alsheikh-Ali ; K. Sulaiman ; H. Alfaleh ; S. Alsaif ; W. Almahmeed ; N. Asaad ; H. Amin ; A. Al-Motarreb ; J. Al Suwaidi
• 刊名：Journal of the Saudi Heart Association
• 出版年：2012
• 出版时间：October, 2012
• 年：2012
• 卷：24
• 期：4
• 页码：271
• 全文大小：222 K

文摘

Introduction

Little in the literature is known about the predictors and the adverse impact of recurrent ischemia and infarction in patients with acute coronary syndrome (ACS). Accordingly; our objectives were to determine the risk factors, and long term outcome of patients with recurrent ischemia.

Methods

We evaluated ACS patients who were enrolled in the second Gulf Registry of Acute Coronary Events (Gulf RACE-2).

Results

Out of 7930 ACS patients, 172 (2.2 % ) developed recurrent myocardial infarction (Re-MI) during their hospitalization. Patients with Re-MI were more likely to be older (mean age 59.12 ¡À 13.5 vs. 56.8 ¡À 12.4; P = 0.016), had higher rates of hyperlipidemia (41.3 % vs. 32.6 % ; P = 0.027) and previous angina (47.7 % vs. 37.9 % ; P = 0.006), presented more with STEMI (72.1 % vs. 43.9 % ; P < 0.001), and had more Killip class 4 upon admission (8.1 % vs. 3.2 % ; P < 0.001) than patients without Re-MI. Management-wise, Re-MI patients received less aspirin (94.8 % vs. 98.5 % ; P = 0.002), beta-blockers (59.3 % vs. 74.7 % ; P < 0.001), and statin (87.2 % vs. 94.9 % ; P < 0.001), and were less frequently assessed by coronary angiogram (30.8 % vs. 32.5 % ; P = 0.036). These patients had more in-hospital complications including congestive heart failure (44.2 % vs. 12.4 % ) and cardiogenic shock (25.6 % vs. 5.3 % ) as well as higher mortality rates; both during hospitalization (23.8 % vs. 4.1 % ) and after a discharge period of 30 days (27.3 % vs. 6.87 % ) and 1 year (29.1 % vs. 9.3 % ). P < 0.001 for all comparisons.

Conclusion

Patients with recurrent infarction have a bad prognosis in terms of in-hospital complications and high mortality rates. High risk patients need to be monitored and managed differently to prevent secondary attacks.