FACTORS ASSOCIATED WITH RECURRENT MYOCARDIAL-INFARCTION WITHIN ONE YEAR AFTER ACUTE MYOCARDIAL-INFARCTION

In a large population of patients (n = 3666) who were discharged from the hospital after acute myocardial infraction and followed up for 1 year, factors associated with recurrent nonfatal (n = 171) or fatal (n = 74) infraction were identified. Also, the effects of combining various end points (recurrent nonfatal or fatal infarction and other cardiac death) in multivariate analyses, a practice common in many small studies that evaluate the predictive value of various treatments or special tests, was examined. In univariate analyses, patients with nonfatal recurrent infarction did not differ with respect to age or gender from infarct-free survivors, but they more often had a history of previous myocardial infraction, congestive heart failure, angina pectoris, and diabetes; more severe pulmonary congestion was present on chest x-ray during the admission, and a non-Q wave index infarction was more frequent. Patients with either a fatal or nonfatal recurrent infraction had more angina pectoris during follow-up (55% to 60%) compared with 27% in event-free survivors and 31% in patients who died of other cardiac causes in whom this factor could be assessed before death. In multivariate analyses, historical and clinical prognostic factors were ranked differently for fatal or nonfatal reinfarction and other cardiac causes of death; angina pectoris at follow-up was highly related to recurrent infarction (fatal or nonfatal), along with a history of diabetes, and a non-Q wave index infarction. These factors were not independently related to other causes of cardiac death. When angina pectoris at follow-up was used in the multivariate analysis of recurrent infarction (fatal plus nonfatal), it was the most important factor. This finding supports the general practice of referring patients with angina pectoris during follow-up (34% of the population) for coronary angiography in an effort to identify those with severe disease who might benefit from revascularization, which is aimed at the prevention of recurrent myocardial infarction.