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Coronary artery disease
Original research
Incidence, predictors, and prognostic impact of recurrent acute myocardial infarction in China
  1. Jiali Song1,
  2. Karthik Murugiah2,3,
  3. Shuang Hu1,
  4. Yan Gao1,
  5. Xi Li1,
  6. Harlan M Krumholz2,3,4,
  7. Xin Zheng1
  8. for the China PEACE Collabortive Group
  1. 1 National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
  2. 2 Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
  3. 3 Yale-New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Connecticut, USA
  4. 4 Yale School of Public Health, Yale University School of Medicine, and Yale-New Haven Hospital, New Haven, Connecticut, USA
  1. Correspondence to Dr. Xin Zheng, National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China; xin.zheng{at}fwoxford.org

Abstract

Background Incidence, predictors, and prognostic impact of recurrent acute myocardial infarction (AMI) after initial AMI remain poorly understood. Data on recurrent AMI in China is unknown.

Methods Using the China Patient-centred Evaluative Assessment of Cardiac Events (PEACE)-Prospective AMI Study, we studied 3387 patients admitted to 53 hospitals for AMI and discharged alive. The association of recurrent AMI with 1-year mortality was evaluated using time-dependent Cox regression. Recurrent AMI events were classified as early (1–30 days), late (31–180 days), and very late (181–365 days). Their impacts on 1-year mortality were estimated by Kaplan-Meier methodology and compared by the log-rank test. Multivariable modelling was used to identify factors associated with recurrent AMI.

Results The mean (SD) age was 60.7 (11.9) years and 783 (23.1%) were women. The observed 1-year recurrent AMI rate was 2.5% (95% CI 2.00 to 3.07) with 35.7% events occurring within the first 30 days. Recurrent AMI was associated with 1-year mortality with an adjusted HR of 25.42 (95% CI 15.27 to 42.34). Early recurrent AMI was associated with the highest 1-year mortality rate of 53.3% (log-rank p<0.001). Predictors of recurrent AMI included age 75–84, in-hospital percutaneous coronary intervention, heart rate >90 min/beats at initial admission, renal dysfunction, and not being prescribed any of guideline-based medications at discharge.

Conclusions One-third of recurrent AMI events occurred early. Recurrent AMI is strongly associated with 1-year mortality, particularly if early. Heightened surveillance during this early period and improving prescription of recommended discharge medications may reduce recurrent AMI in China.

  • acute myocardial infarction
  • quality and outcomes of care
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/heartjnl-2020-317165

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    Footnotes

    • JS and KM are joint first authors.

    • HMK and XZ are joint senior authors.

    • Contributors JS and XZ conceived of this article. JS and KM wrote the manuscript with further contributions from XZ, XL, SH, YG and HMK. JS, SH and YG completed all the statistical analysis. All authors interpreted data, contributed to critical revisions and approved the final version of the article.

    • Funding This project was supported by the National Key Research and Development Programme (2017YFC1310803) from the Ministry of Science and Technology of China, the CAMS Innovation Fund for Medical Science (2016-I2M-1-006), and the 111 Project (B16005) from the Ministry of Education of China.

    • Competing interests HMK is the recipient of a research grant from Medtronic and Johnson & Johnson, through Yale University, to develop methods of clinical trial data sharing; chairs a cardiac scientific advisory board for United Health; works under contract with the Centers for Medicare & Medicaid Services to develop and maintain performance measures that are publicly reported; is a participant/participant representative of the IBM Watson Health Life Sciences Board; is a member of the Advisory Board for Element Science and the Physician Advisory Board for Aetna; and is the founder of Hugo, a personal health information platform. HMK and KM work under contract with the Centers for Medicare & Medicaid Services to develop and maintain performance measures that are publicly reported

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Ethics approval The central ethics committee at Fuwai Hospital, local ethics committees at participating hospitals and the Yale University Institutional Review Board approved the China Peace-Prospective AMI Study.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement No data are available. It is our future plan to share the data of this study. However, we are unable to do so at this time.