†High Rates of Cardiovascular Events in Patients with Multivessel Disease in the First Year Post-Myocardial Infarction: A Systematic Literature Review

Abstract

Study Funding

This study was sponsored by CSL Behring and performed in collaboration with the Baim Institute.

Background/Synopsis

Patients who survive an acute myocardial infarction (AMI) are at a heightened risk of further major adverse cardiovascular events (MACE), particularly in the first few months following an AMI. Multivessel disease (MVD) is known to further exacerbate the risk of MACE. The elevated risk in this early post-AMI period is not addressed by current secondary preventative therapies.

Objective/Purpose

To evaluate the impact of MVD on clinical and patient-centered outcomes in the first year post-AMI, in the context of the current treatment landscape.

Methods

In this systematic literature review, relevant articles published between March 2019 and July 2022 were identified from MEDLINE, Embase, Cochrane databases, and cardiovascular (CV) and health outcomes conferences. Articles reporting on pre-specified clinical or patient-centered outcomes in post-AMI patients with MVD at timepoints within 1 year were eligible for inclusion. Studies that included patients with AMI and cardiogenic shock were excluded from this review.

Results

Clinical outcomes were reported in five randomized-controlled trials (RCTs) and 25 observational studies across 32 articles. Patient-centered outcomes were reported in one RCT across two articles. The definition of MVD varied across the studies; however, it was typically characterized by ≥50% stenosis in ≥1 non-infarct-related coronary artery. Of the individual MACE endpoints extracted for this review (all-cause mortality, CV mortality, AMI, stroke), all-cause mortality and AMI were most frequently reported. Although rates of individual MACE endpoints were variable (Table), likely due to heterogeneity in study populations and interventions, a trend was identified; MACE rates at 1-year post-AMI were typically not substantially higher than those reported at earlier timepoints. EQ-5D scores, indicative of quality of life (QoL), increased marginally from baseline to 1 year following treatment, indicating minimal improvements in QoL. Nevertheless, EQ-5D was only reported in one RCT.

Conclusions

MVD is associated with high rates of MACE early after AMI that persist at 1 year. Novel therapies that address CV risk in the early period post-AMI may support improved CV outcomes among patients with MVD. Further data on patient-centered outcomes are warranted to determine the impact of post-AMI treatment options on QoL.