Comparative long-term prognosis of acute myocardial infarction and acute aortic dissection in a population-based registry.

Abstract

Aims: Acute myocardial infarction (AMI) and acute aortic dissection (AAD) are major cardiovascular emergencies with high mortality; however, their long-term prognoses have rarely been directly compared within the same population. Understanding differences in real-world outcomes between these conditions is important for patient informing and evaluation of cardiovascular care.

Methods and results: We analysed 1923 patients enrolled in the Shiga Stroke and Heart Attack Registry, a population-based registry covering an entire Shiga Prefecture in Japan, who developed AMI or AAD between 2014 and 2015. The primary outcome was all-cause death, and the secondary outcome was cardiovascular death during 5-year follow-up. Hazard ratios (HRs) were estimated using multivariable Cox models adjusted for age and sex. Landmark analyses beyond 30 days evaluated outcomes among early survivors. Of the total cohort, 1550 were AMI [ST-elevation myocardial infarction (MI): n = 902 (58%); non-ST-elevation MI: n = 464 (30%); and sudden cardiac death due to MI: n = 184 (12%)], and 373 were AAD [type A: n = 219 (59%); type B: n = 154 (41%)]. Five-year all-cause mortality was higher in AAD than AMI [50.0% vs. 35.4%; adjusted HR 1.53, 95% confidence interval (CI) 1.29-1.83; P < 0.001]. Cardiovascular mortality was also higher in AAD (38.7% vs. 27.4%; adjusted HR 1.41, 95% CI 1.17-1.71; P < 0.001). Landmark analysis showed that excess mortality in AAD was mainly driven by early deaths, whereas cardiovascular mortality among 30-day survivors was similar between diseases.

Conclusion: In this population-based study in Japan, AAD was associated with worse 5-year survival than AMI. Among acute-phase survivors, long-term cardiovascular outcomes were comparable.