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
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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
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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)