Managed Care after Acute Myocardial Infarction (MC-AMI) – a Poland's nationwide program of comprehensive post-MI care - improves prognosis in 12-month follow-up. Preliminary experience from a single high-volume center. (1st December 2019)

• Record Type: Journal Article
• Authors: Wita, Krystian; Wilkosz, Katarzyna; Wita, Marcin; Kułach, Andrzej; Wybraniec, Maciej T.; Polak, Mateusz; Matla, Monika; Maciejewski, Łukasz; Fluder, Joanna; Kalańska-Łukasik, Barbara; Skowerski, Tomasz; Gomułka, Szymon; Turski, Maciej; Szydło, Krzysztof
• Is Part Of: International journal of cardiology. Volume 296(2019)
• Page Start: 8
• Page End: 14
• Publication Date: 2019-12-01
• Subjects: Cardiac rehabilitation -- Myocardial infarction -- Cardiovascular prevention -- MACCE -- Post MI prognosis -- MC-AMI; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2019.06.040
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Despite progress in the treatment of acute myocardial infarction (AMI), long-term prognosis in MI survivors remains a challenge. The Managed Care in Acute Myocardial Infarction (MC-AMI, KOS-zawal) is the first program of a comprehensive, supervised care for patients with AMI to improve long-term prognosis. It includes acute intervention, complex revascularization, cardiac rehabilitation (CR), outpatient follow-up, and prevention of SCD. Our aim was to assess the relation between participation in MC-AMI and major adverse cardiovascular and cerebrovascular events (MACCE) in 12-month follow-up. Methods and results: In this single-center, retrospective analysis we compared 719 patients participating in MC-AMI and compared them to 1130 subjects in the control group. After propensity score matching, two groups of 529 subjects each were compared. MC-AMI was related with MACCE reduction by 40% in a 12-month observation. Participants of MC-AMI had a higher adherence to cardiac rehabilitation (98 vs. 14%), higher rate of scheduled revascularisation (coronary artery bypass grafting: 9.8% vs. 4.9%, p ≪ 0.001; elective percutaneous coronary intervention: 3.0% vs 2.1%, p ≪ 0.05) and ICD implantation (2.8% vs. 0.6%, p ≪ 0.05) compared to control. Multivariable Cox regression analysis revealed MC-AMI to be inversely associated with the occurrence of MACCE (HR = 0.500, 95% Cl 0.349–0.718, p ≪ 0.001). Besides, older age, diabetes mellitus, hyperlipidemia, prior PAD, previous UA, and lower LVEF were significantly associated with the primary endpoint. Conclusions: MC-AMI is the first program of comprehensive care for AMI patients. MC-AMI improves prognosis by increasing the rate of patients undergoing CR, complete revascularization and ICD implantation, thus reducing MACCE. Highlights: MC-AMI is a care model including revascularization, rehabilitation and prevention of SCD after MI. Managed Care in Acute Myocardial Infarction reduces MACCE by 40% in 12-month follow-up. Strict and complex approach after MI warrants better results within the same healthcare resources.