Recurrent myocardial infarction: clinical, anamnestic and epidemiological aspects

Abstract

Highlights. Recurrent myocardial infarction remains an important health problem due to the high mortality of patients. At the same time, there is practically no data in the literature on the prevalence of this complication in the population, which makes studies carried out on the basis of long-term epidemiological programs relevant. The analysis of the “Acute Myocardial Infarction Register” (Tomsk) presented in the paper showed not only a high mortality rate of patients with recurrent infarction, but also a tendency to increase the incidence of this complication, which confirms the need to search for predictors of its occurrence.Aim. To determine the incidence of recurrent myocardial infarction (RMI) and mortality in patients with RMI in Tomsk for five years (2016–2020), to perform a clinical and anamnestic analysis of RMI episodes registered in 2019 and 2020.Methods. The study was performed on the basis of the data from the information and analytical database of the WHO program “Registry of Acute Myocardial Infarction”. In 2019–2020 1748 cases of acute myocardial infarction (AMI) were registered, in 1078 men (61.7%) and 670 women (38.3%). 87 patients with RMI were identified, which accounted for 5%. In this group, there were 46 men (52.9%) and 41 (47.1%) women. The age of RMI patients was almost identical (72.2±12.7 years old in men and 72.1±11.4 years old in women).Results. 51 (58.6%) patients were hospitalized with index AMI in a specialized department, 14 (16.1%) were treated in non-core hospitals and 22 (25.3%) people died at the prehospital stage. Patients with AMI with RMI and without RMI did not differ in clinical and anamnestic parameters. Coronary ventriculography was performed in 51 (58.6%) patients with RMI, in 41 (80.4%) cases there was a multivessel lesion of the coronary bed. RMI occurred in 43 (49.4%) patients who were treated in hospital, in 22 (25.3%) – at home, after discharge. RMI was detected in 22 (25.3%) of the dead at the prehospital stage. Typical and atypical clinical manifestations of RMI occurred in 53% and 47%, respectively. Stent thrombosis (24.1%) and the lack of treatment for indexAMI (35.6%) prevailed among the causes of RMI. It was not possible to establish the cause in 27.6% of cases. An increase in the incidence of RMI was noted from 2016 to 2020. During the follow-up, the mortality rate from RMI was two times higher than that among AMI patients in general.Conclusion. There were no significant clinical, anamnestic and other differences among patients with and without RMI. The established causes of RMI are not so much causes as a consequence of some factors. This fact, combined with the high mortality rate from RMI and the trend towards an increase in the incidence of RMI, makes it necessary to search for predictors of the onset of RMI and ways to prevent them.