Secondary prevention strategies after an acute ST-segment elevation myocardial infarction in the AMI code era: beyond myocardial mechanical reperfusion. Issue 1 (December 2017)

• Record Type: Journal Article
• Authors: Ribas, Núria; García-García, Cosme; Meroño, Oona; Recasens, Lluís; Pérez-Fernández, Silvia; Bazán, Víctor; Salvatella, Neus; Martí-Almor, Julio; Bruguera, Jordi; Elosua, Roberto
• Is Part Of: BMC cardiovascular disorders. Volume 17:Issue 1(2017)
• Page Start: 1
• Page End: 9
• Publication Date: 2017-12
• Subjects: ST-segment elevation myocardial infarction -- Coronary angioplasty -- Secondary prevention -- Prognosis -- Reperfusion therapy -- Cardiovascular risk factors; Cardiovascular system -- Diseases -- Periodicals; 616.12005
• DOI: 10.1186/s12872-017-0493-6
• Languages: English
• ISSNs: 1471-2261

Abstract

Abstract Background TheAMI code is a regional network enhancing a rapid and widespread access to reperfusion therapy (giving priority to primary angioplasty) in patients with acute ST-segment elevation myocardial infarction (STEMI). We aimed to assess the long-term control of conventional cardiovascular risk factors after a STEMI among patients included in theAMI code registry. Design and methods Four hundred and fifty-four patients were prospectively included between June-2009 and April-2013. Clinical characteristics were collected at baseline. The long-term control of cardiovascular risk factors and cardiovascular morbidity/mortality was assessed among the 6-months survivors. Results A total of 423 patients overcame the first 6 months after the STEMI episode, of whom 370 (87%) underwent reperfusion therapy (363, 98% of them, with primary angioplasty). At 1-year follow-up, only 263 (62%) had adequate blood pressure control, 123 (29%) had LDL-cholesterol within targeted levels, 126/210 (60%) smokers had withdrawn from their habit and 40/112 (36%) diabetic patients had adequate glycosylated hemoglobin levels. During a median follow-up of 20 (11–30) months, cumulative mortality of 6 month-survivors was 6.1%, with 9.9% of hospital cardiovascular readmissions. The lack of assessment of LDL and HDL-cholesterol were significantly associated with higher mortality and cardiovascular readmission rates. Conclusions Whereas implementation of theAMI code resulted in a widespread access to rapid reperfusion therapy, its long-term therapeutic benefit may be partially counterbalanced by a manifestly suboptimal control of cardiovascular risk factors. Further efforts should be devoted to secondary prevention strategies after STEMI.