Cardiovascular risk in post-myocardial infarction patients: nationwide real world data demonstrate the importance of a long-term perspective
Abstract
AIMS: Long-term disease progression following myocardial infarction (MI) is not well understood. We examined the risk of subsequent cardiovascular events in patients discharged after MI in Sweden. METHODS AND RESULTS: This was a retrospective, cohort study linking morbidity, mortality, and medication data from Swedish national registries. Of 108 315 patients admitted to hospital with a primary MI between 1 July 2006 and 30 June 2011 (index MI), 97 254 (89.8%) were alive 1 week after discharge and included in this study. The primary composite endpoint of risk for non-fatal MI, non-fatal stroke, or cardiovascular death was estimated for the first 365 days post-index MI and Day 366 to study completion. Risk and risk factors were assessed by Kaplan-Meier analysis and Cox proportional hazards modelling, respectively. Composite endpoint risk was 18.3% during the first 365 days post-index MI. Age [60-69 vs. <60 years: HR (95% CI): 1.37 (1.30-1.45); 70-79 vs. <60 years: 2.13 (2.03-2.24); >80 vs. <60 years: 3.96 (3.78-4.15)], prior MI [1.44 (1.40-1.49)], stroke [1.49 (1.44-1.54)], diabetes [1.37 (1.34-1.40)], heart failure [1.57 (1.53-1.62)] and no index MI revascularisation [1.88 (1.83-1.93)] were each independently associated with a higher risk of ischaemic events or death. For patients without a combined endpoint event during the first 365 days, composite endpoint risk was 20.0% in the following 36 months. CONCLUSIONS: Risk of cardiovascular events appeared high beyond the first year post-MI, indicating a need for prolonged surveillance, particularly in patients with additional risk factors.
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Patients who have had an acute coronary syndrome are at high risk for recurrent ischemic cardiovascular events.
“Patients who have had an acute coronary syndrome are at high risk for recurrent ischemic cardiovascular events.”
From Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome (2018) · cites this paper as [2]
The Results report an 18.3% one-year risk of MI, stroke, or cardiovascular death after an index MI, and the Discussion says risk remained high in subsequent years. This supports the claim for patients after MI, but the study does not establish the same risk for all patients after acute coronary syndrome, a broader group. (LLM, conf=0.84)
Experimental — accuracy not yet measuredElderly patients with a recent myocardial infarction remain at high risk of subsequent events despite significant improvements in secondary prophylaxis.
“Despite significant improvements in secondary prophylaxis, the risk of subsequent events remains high in elderly after myocardial infarction.”
From Effects of n-3 Fatty Acid Supplements in Elderly Patients After Myocardial Infarction (2021) · cites this paper as [1]
The Results (page unavailable) show that subsequent-event risk rose sharply with age among stable post-MI patients, reaching 59.1% in those aged 80 or older. The paper reports use of guideline-recommended therapies and mentions improved treatments in its Introduction, but it does not establish significant improvements specifically in secondary prophylaxis. (LLM, conf=0.84)
Experimental — accuracy not yet measuredRecurrent ischemia causing adverse cardiovascular events after optimal acute coronary syndrome treatment occurs in about 10% of randomized controlled trial subjects and nearly doubles in real-world registries.
“Recurrent ischemia resulting in adverse CV events following optimal treatment for an acute coronary syndrome occurs in approximately 10% of subjects in randomized controlled trials (RCTs) (2), and this number nearly doubles in real-world registries (3).”
From Thyroid Hormones and Cardiovascular Function and Diseases (2018) · cites this paper as [3]
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- Authors
- Jernberg, T., Hasvold, P., Henriksson, M., Hjelm, H., Thuresson, M., & Janzon, M.
- Affiliations
- Karolinska University Hospital (SE)
- AstraZeneca (Sweden) (SE)
- Region Sörmland (SE)
- Statisticon (Sweden) (SE)
- Linköping University (SE)
- Corresponding author
- Jernberg, Tomas
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2015-01-13
- Volume
- 36
- Issue
- 19
- Pages
- 1163-1170
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W2169252817
- Semantic Scholar
- 5a690e11eebe02d79ff8c97154c07f13b09881b9
- Cited by
- 875
- References
- 29
- Citations by year
- 2026: 66 · 2025: 85 · 2024: 76 · 2023: 87 · 2022: 88 · 2021: 92 · 2020: 97 · 2019: 80 · 2018: 70 · 2017: 60 · 2016: 53 · 2015: 20
- FWCI
- 49.25
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- Funders
- AstraZeneca
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- myocardial infarction, cardiovascular risk, long-term prognosis, cardiovascular events, reinfarction, stroke, cardiovascular mortality, risk factors, age, old myocardial infarction, diabetes mellitus, heart failure, revascularization, post-discharge surveillance, first myocardial infarction
- MeSH terms
- Adult, Aged, Aged, 80 and over, Cardiovascular Diseases, Epidemiologic Methods, Female, Hospitalization, Humans, Male, Middle Aged, Myocardial Infarction, Sweden, Disease Progression, Stroke, Kaplan-Meier Estimate
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