All STEMI patients enrolled from 2002 to 2014 in the AMIS Plus registry were included. Outcome was analyzed using logistic multivariate regression.
From 19,665 STEMI patients, 2845 (14%) had reMI. These patients were older (69.5y vs. 64.2y; p < 0.001), more frequently male, with more risk factors (hypertension, dyslipidemia), and more comorbidities. Patients with reMI presented 25 min earlier than those with first MI, were more frequently in Killip class 3/4 (12% vs. 7%; p < 0.001), and were less likely to receive guideline-recommended drug therapy: aspirin (93% vs. 97%; p < 0.001), P2Y12 inhibitors (76% vs. 83%; p < 0.001), or statins (73% vs. 77%; p < 0.001), or undergo primary percutaneous coronary intervention (77% vs. 87%; p < 0.001). These patients developed more frequently cardiogenic shock (7% vs. 5%; p < 0.001) and reinfarction (2% vs. 1%; p < 0.001) during hospitalization, and had higher crude mortality (10% vs. 5%; p < 0.001) than patients without prior MI. Prior MI was an independent predictor of in-hospital mortality in STEMI patients (OR 1.27; 95% CI 1.05–1.53; p < 0.001).
A subgroup (n = 4486) was followed 1 year after discharge (3893 with first MI and 593 with reMI at initial hospitalization). Crude mortality was 2.9% for patients with first MI vs. 6.7% for those with reMI (OR 1.68, 95% CI 1.14–2.47; p = 0.008).
Although patients with reMI are high-risk patients, they were less likely to receive evidence-based treatment and had worse in-hospital and 1-year outcomes compared to patients with first MI. Short- and long-term management of patients with recurring MI should be improved.