Clinical Impact of Self-Recognition of Recurrent Acute Myocardial Infarction: From KRMI-RCC
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Collection and Study Approval
2.2. Study Population
2.3. Statistical Analysis
3. Results
3.1. Baseline Characteristics of the Self-Recognised MI Group and the Unrecognised MI Group
3.2. Presenting Symptoms, Patient Response and Revascularization Treatment During re-MI
3.3. Multivariate Analysis of Self-Recognised MIs for Clinical Outcomes
3.4. Clinical Outcomes between the Self-Recognised MI and Unrecognised MI Groups
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Self-Recognised N = 533 (52.4%) | Unrecognised N = 485 (47.6%) | p-Value | |
---|---|---|---|
Female | 112 (20.7%) | 158 (31.0%) | <0.001 |
Age | 67 [59, 75] | 73 [64, 80] | <0.001 |
Body mass index, kg/m2 | 23.9 [22.1, 26.0] | 23.7 [21.5, 26.1] | 0.380 |
Diagnosis | 0.677 | ||
STEMI | 140 (26.3%) | 133 (27.4%) | |
NSTEMI | 393 (73.7%) | 352 (72.6%) | |
Systolic blood pressure, at arrival | 130 [110, 150] | 128 [110, 150] | 0.003 |
Diastolic blood pressure, at arrival | 80 [70, 90] | 75 [60, 90] | <0.001 |
Heart rate, at arrival (beats per minute) | 78 [67, 92] | 80 [67, 94] | 0.321 |
Cardiogenic shock at arrival | 19 (3.6%) | 28 (5.8%) | 0.094 |
Worsened heart failure at arrival | 63 (11.8%) | 80 (16.5%) | 0.032 |
Cardiovascular risk factors | |||
Hypertension | 341 (64.0%) | 309 (63.7%) | 0.930 |
Dyslipidaemia (patient-reported) | 107 (20.1%) | 66 (13.6%) | 0.006 |
Diabetes mellitus | 251 (47.1%) | 225 (46.4%) | 0.823 |
On dialysis | 40 (7.5%) | 50 (10.3%) | 0.115 |
Prior PCI | 494 (92.7%) | 431 (88.9%) | 0.035 |
Prior CABG | 31 (5.8%) | 22 (4.5%) | 0.359 |
Prior stroke | 43 (8.1%) | 75 (15.5%) | <0.001 |
Prior PAD | 7 (1.3%) | 4 (0.8%) | 0.552 |
Previously registered subjects | 345 (64.7%) | 255 (52.6%) | <0.001 |
Prior cancer | 21 (3.9%) | 44 (9.1%) | 0.001 |
Smoking | 0.211 | ||
Current smoker | 147 (27.6%) | 116 (23.9%) | |
Ex-smoker | 157 (29.5%) | 135 (27.8%) | |
Never | 229 (43.0%) | 234 (48.2%) | |
Type of Insurance | 0.661 | ||
Medical insurance | 493 (92.5%) | 441 (90.9%) | |
Medical care or non-benefits | 40 (7.5%) | 44 (9.1%) | |
Education levels | 0.001 | ||
Elementary school | 120 (22.5%) | 148 (30.5%) | |
Middle school | 65 (12.2%) | 80 (16.5%) | |
High school | 184 (34.5%) | 149 (30.7%) | |
College/university | 116 (23.9%) | 65 (14.7%) | |
Unknown | 48 (9.0%) | 43 (8.9%) | |
Types of Households | 0.067 | ||
Solitary or alone | 90 (16.9%) | 110 (22.7%) | 0.020 |
Living with family | 433 (81.2%) | 366 (75.5%) | 0.025 |
with spouse | 376 (70.5%) | 296 (61.0%) | 0.001 |
with parents | 122 (22.9%) | 115 (23.7%) | 0.757 |
with son or daughter | 111 (20.8%) | 112 (23.1%) | 0.382 |
with housemate | 10 (1.9%) | 9 (1.9%) | 0.981 |
Laboratory findings | |||
eGFR, mL/min/1.73 m2 | 72 [53, 89] | 69 [42, 91] | 0.003 |
Haemoglobin, g/dL | 13.5 [11.7, 14.9] | 12.7 [10.9, 14.2] | <0.001 |
HbA1c, % | 6.2 [5.7, 7.3] | 6.0 [5.6, 7.0] | 0.033 |
Total cholesterol, mg/dL | 137 [114, 162] | 137 [113, 174] | 0.281 |
High-density lipoproteinemia, mg/dL | 40 [34, 48] | 40 [34, 48] | 0.281 |
Low-density lipoproteinemia, mg/dL | 78, [61, 98] | 80 [61, 108] | 0.235 |
LVEF, % | 50 [41, 59] | 48 [37, 57] | 0.003 |
LVEDD, mm | 51 [47, 55] | 51 [46, 56] | 0.640 |
Recognised symptoms at the development of acute myocardial infarction | |||
Chest pain | 495 (92.9%) | 410 (84.7%) | <0.001 |
Difficult breathing | 171 (32.1%) | 158 (34.7%) | 0.386 |
Cold sweats | 167 (31.4%) | 100 (20.7%) | <0.001 |
Radiating pain | 146 (27.4%) | 96 (19.8%) | 0.004 |
Vertigo/light-headedness/unconsciousness | 45 (8.6%) | 80 (16.3%) | 0.004 |
stomach-ache | 7 (1.3%) | 10 (2.1%) | 0.352 |
Number of MI symptoms | 1.9 ± 0.9 | 1.8 ± 0.9 | 0.008 |
(2 or more) | 342 (64.2%) | 270 (55.7%) | 0.006 |
Place where symptoms occurred | 0.915 | ||
At home | 361 (67.7%) | 330 (68.0%) | |
Outside of the home | 172 (32.3%) | 155 (32.0%) | |
Symptom to arrival time, median, min | 139 [60, 338] | 190 [91, 661] | 0.056 |
≤60 min | 122 (25.2%) | 87 (19.8%) | 0.051 |
≤90 min | 177 (36.5%) | 109 (24.8%) | <0.001 |
≤120 min | 223 (46.0%) | 154 (35.0%) | <0.001 |
Among STEMI, median, min | 84 [40, 182] | 127 [61, 291] | 0.017 |
≤60 min | 56 (40.9%) | 33 (24.8%) | 0.005 |
≤90 min | 72 (52.6%) | 42 (31.6%) | <0.001 |
≤120 min | 92 (67.2%) | 62 (46.6%) | 0.001 |
Among NSTEMI, median, min | 180 [74, 414] | 230 [104, 852] | 0.242 |
≤90 min | 105 (30.2%) | 67 (21.8%) | 0.015 |
Methods of transportation to the PCI-capable hospital | 0.204 | ||
Ambulance | 298 (56.1%) | 303 (62.5%) | |
Own car | 188 (35.4%) | 154 (31.8%) | |
Public transport | 35 (6.6%) | 24 (5.0%) | |
On foot | 9 (1.7%) | 4 (0.8%) | |
Inter-hospital transfer | 183 (36.0%) | 122 (22.6%) | <0.001 |
Performed PCI | 467 (87.6%) | 416 (85.8%) | 0.386 |
Use for a mechanical support device | 11 (2.1%) | 12 (2.5%) | 0.660 |
Treatment status of STEMI | 0.355 | ||
Primary PCI | 120 (98.4%) | 112 (97.4%) | |
Thrombolysis | 1 (0.8%) | 0 (0.0%) | |
Conservative Tx | 1 (0.8%) | 3 (2.6%) | |
Symptoms to Device time, min (median) | 135 [98, 225] | 182 [117, 313] | |
Symptoms to Device time, min (avg.) | 196 ± 192 | 591 ± 1730 | 0.018 |
Treatment status of NSTEMI * | |||
PCI within 24 h from arrival * | 244 (62.1%) | 197 (56.0%) | 0.173 |
Conservative Therapy | 43 (10.9%) | 54 (15.3%) | |
Angiographic findings | |||
Infarct-related artery | 0.844 | ||
Left anterior descending artery | 197 (37.0%) | 178 (36.7%) | |
Right coronary artery | 145 (27.2%) | 139 (28.7%) | |
Left circumflex artery | 94 (17.6%) | 75 (15.5%) | |
Left main | 18 (3.4%) | 15 (3.1%) | |
Unknown or undetermined | 79 (14.8%) | 78 (16.1%) | |
The number of vessels | 0.054 | ||
0 | 24 (5.1%) | 12 (2.9%) | |
1 | 259 (55.5%) | 206 (49.5%) | |
2 | 127 (27.2%) | 137 (32.9%) | |
3 | 57 (12.2%) | 61 (14.7%) | |
Left main disease | 44 (9.4%) | 34 (8.1%) | 0.757 |
Left anterior descending artery stenosis ≥ 75% | 151 (32.3%) | 155 (37.2%) | 0.256 |
Complete revascularization | 375 (80.3%) | 324 (77.9%) | 0.378 |
Performed bypass surgery | 8 (1.5%) | 8 (1.6%) | 0.849 |
Variables | Multivariate Analysis | ||
---|---|---|---|
OR | 95% CI | p-Value | |
Male | 1.55 | 1.10–2.19 | 0.013 |
Age ≥ 70-year-old | 0.57 | 0.42–0.76 | <0.001 |
Education beyond university | 1.41 | 0.98–2.03 | 0.062 |
Living with spouse | 1.28 | 0.94–1.74 | 0.116 |
Prior dyslipidaemia | 1.58 | 1.08–2.30 | 0.018 |
Prior stroke | 0.54 | 0.35–0.84 | 0.006 |
Previously enrolled KRMI-RCC | 1.78 | 1.35–2.36 | <0.001 |
A history of cancer | 0.33 | 0.18–0.61 | <0.001 |
Prior PCI | 1.34 | 0.82–2.19 | 0.243 |
MI symptoms (2 or more) | 1.39 | 1.05–1.84 | 0.021 |
Self-Recognition N = 533 | Unrecognition N = 485 | p-Value | |
---|---|---|---|
Hospital stay, days | 8 ± 9 | 7 ± 18 | 0.235 |
In-hospital events | |||
Cardiac arrest | 10 (1.9%) | 28 (5.8%) | <0.001 |
Cerebrovascular event | 1 (0.2%) | 4 (0.8%) | 0.159 * |
Cardiogenic shock | 23 (4.3%) | 43 (8.9%) | 0.003 |
Atrial fibrillation | 33 (6.2%) | 51 (10.5%) | 0.012 |
Heart failure | 57 (10.7%) | 71 (14.6%) | 0.036 |
Ventricular tachycardia or ventricular fibrillation | 23 (4.3%) | 29 (6.0%) | 0.144 |
Need for haemodialysis | 34 (6.4%) | 37 (7.6%) | 0.255 |
In-hospital death | 8 (1.5%) | 30 (6.2%) | <0.001 |
A composite of in-hospital events (cardiac arrest, cardiogenic shock, stroke, heart failure, ventricular fibrillation/tachycardia, haemodialysis, and cardiac death) | 111 (20.8%) | 144 (29.7%) | 0.001 |
Clinical outcomes at 1-year follow-up after discharge * | N = 417 | N = 362 | |
All-cause mortality | 28 (6.6%) | 48 (13.5%) | 0.001 |
Cause of death | 0.029 | ||
Cardiac death | 15 (53.6%) | 25 (52.1%) | |
Non-cardiac death | 12 (42.9%) | 11 (22.9%) | |
Undetermined | 1 (3.6%) | 12 (25.0%) | |
Non-fatal myocardial infarction | 34 (7.9%) | 17 (4.8%) | 0.051 |
Cerebrovascular accident | 4 (0.9%) | 5 (1.4%) | 0.529 |
Rehospitalisation for heart failure | 14 (3.2%) | 12 (3.4%) | 0.913 |
Stent thrombosis | 8 (1.9%) | 0 (0.0%) | 0.010 |
A composite of all clinical events at 12-month follow-up (all-cause death, stroke, heart failure, myocardial infarction) | 78 (14.6%) | 105 (21.6%) | 0.004 |
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Kim, K.; Kim, M.; Seo, C.-O.; Kim, H.; Kim, H.R.; Kang, M.G.; Koh, J.-S.; Park, J.R.; Kim, R.B.; Ryu, D.R.; et al. Clinical Impact of Self-Recognition of Recurrent Acute Myocardial Infarction: From KRMI-RCC. J. Clin. Med. 2024, 13, 4840. https://doi.org/10.3390/jcm13164840
Kim K, Kim M, Seo C-O, Kim H, Kim HR, Kang MG, Koh J-S, Park JR, Kim RB, Ryu DR, et al. Clinical Impact of Self-Recognition of Recurrent Acute Myocardial Infarction: From KRMI-RCC. Journal of Clinical Medicine. 2024; 13(16):4840. https://doi.org/10.3390/jcm13164840
Chicago/Turabian StyleKim, Kyehwan, Moojun Kim, Chang-Ok Seo, Hangyul Kim, Hye Ree Kim, Min Gyu Kang, Jin-Sin Koh, Jeong Rang Park, Rock Bum Kim, Dong Ryeol Ryu, and et al. 2024. "Clinical Impact of Self-Recognition of Recurrent Acute Myocardial Infarction: From KRMI-RCC" Journal of Clinical Medicine 13, no. 16: 4840. https://doi.org/10.3390/jcm13164840