Mortality and morbidity trends after the first year in survivors of acute myocardial infarction: a systematic review

BMC Cardiovascular Disorders, Feb 2017

Background Most studies of outcomes after myocardial infarction (MI) focus on the acute phase after the index event. We assessed mortality and morbidity trends after the first year in survivors of acute MI, by conducting a systematic literature review. Methods Literature searches were conducted in Embase, MEDLINE, and the Cochrane Database of Systematic Reviews to identify epidemiological studies of long-term (>10 years) mortality and morbidity trends in individuals who had experienced an acute MI more than 1 year previously. Results Thirteen articles met the inclusion criteria. Secular trends showed a consistent decrease in mortality and morbidity after acute MI from early to more recent study periods. The relative risk for all-cause death and cardiovascular outcomes (recurrent MI, cardiovascular death) was at least 30% higher than that in a general reference population at both 1–3 years and 3–5 years after MI. Risk factors leading to worse outcomes after MI included comorbid diabetes, hypertension and peripheral artery disease, older age, reduced renal function, and history of stroke. Conclusions There have been consistent improvements in secular trends for long-term survival and cardiovascular outcomes after MI. However, MI survivors remain at higher risk than the general population, particularly when additional risk factors such as diabetes, hypertension, or older age are present.

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Mortality and morbidity trends after the first year in survivors of acute myocardial infarction: a systematic review

Johansson et al. BMC Cardiovascular Disorders Mortality and morbidity trends after the first year in survivors of acute myocardial infarction: a systematic review Saga Johansson 2 Annika Rosengren 0 1 Kate Young 4 Em Jennings 3 0 Sahlgrenska University Hospital , Gothenburg , Sweden 1 Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden 2 AstraZeneca Gothenburg , Pepparedsleden 1, S-431 83 Mölndal , Sweden 3 AstraZeneca R&D , 132 Hills Rd, Cambridge CB2 1PG , UK 4 Research Evaluation Unit , Oxford PharmaGenesis, 503 Washington Ave, Newtown, PA 18940 , USA Background: Most studies of outcomes after myocardial infarction (MI) focus on the acute phase after the index event. We assessed mortality and morbidity trends after the first year in survivors of acute MI, by conducting a systematic literature review. Methods: Literature searches were conducted in Embase, MEDLINE, and the Cochrane Database of Systematic Reviews to identify epidemiological studies of long-term (>10 years) mortality and morbidity trends in individuals who had experienced an acute MI more than 1 year previously. Results: Thirteen articles met the inclusion criteria. Secular trends showed a consistent decrease in mortality and morbidity after acute MI from early to more recent study periods. The relative risk for all-cause death and cardiovascular outcomes (recurrent MI, cardiovascular death) was at least 30% higher than that in a general reference population at both 1-3 years and 3-5 years after MI. Risk factors leading to worse outcomes after MI included comorbid diabetes, hypertension and peripheral artery disease, older age, reduced renal function, and history of stroke. Conclusions: There have been consistent improvements in secular trends for long-term survival and cardiovascular outcomes after MI. However, MI survivors remain at higher risk than the general population, particularly when additional risk factors such as diabetes, hypertension, or older age are present. Long-term; Morbidity; Mortality; Myocardial infarction; Risk factors - Background The incidence of acute myocardial infarction (AMI) and case-fatality rates after AMI are declining in most countries, especially in those with high per capita incomes [1–3]. However, the aging world population, population growth, and the rising prevalence of long-term survivors of AMI mean that the burden of disease is generally increasing [1]. Secular trends in reduced morbidity and mortality in individuals with acute coronary syndromes, including AMI, are underpinned by advances in treatment and by the implementation of processes of care, such as networks for the treatment of ST-elevation MI (STEMI) [4, 5]. * Correspondence: 1AstraZeneca Gothenburg, Pepparedsleden 1, S-431 83 Mölndal, Sweden Full list of author information is available at the end of the article Survivors of AMI are at high risk of a recurrent myocardial infarction (MI), as well as other manifestations of cardiovascular (CV) disease such as stroke [6–8]. Most studies of post-MI outcomes focus on the acute phase after the index event, with few data available for followup beyond the first year. However, although the risk of CV events is highest in the first year post-index MI, it remains elevated in subsequent years [9, 10]. The objective of this systematic literature review was to assess whether morbidity and mortality in survivors of AMI after the first year mirror the general secular trend observed in survivors of MI, based on the results of epidemiological studies describing morbidity and mortality trends covering at least 10 years in long-term (>1 year) survivors of AMI. © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Methods Systematic review Literature searches were conducted in June 2015 in Embase, MEDLINE, and the Cochrane Database of Systematic Reviews to identify epidemiological studies of long-term (≥10-year) morbidity and mortality trends in individuals who had experienced an AMI more than 1 year previously. The following search string was used: ((acute coronary syndrome.mp.) OR ((myocardium OR myocardial) AND (ischemi* OR ischaemi*)).mp. OR (coronary heart disease.mp.) OR (coronary artery disease.mp.) OR (myocardial infarction.mp.) OR (unstable angina.mp.)) AND ((natural history.mp.) OR (longitudinal study.mp.) OR (survival.mp.) OR ((secular or time) adj1 trend*).mp. OR ((long term or long-t (...truncated)


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Saga Johansson, Annika Rosengren, Kate Young, Em Jennings. Mortality and morbidity trends after the first year in survivors of acute myocardial infarction: a systematic review, BMC Cardiovascular Disorders, 2017, pp. 53, 17, DOI: 10.1186/s12872-017-0482-9