Trends in mortality and major adverse cardiovascular events following incident acute myocardial infarction

Abstract Background and aims Assessment of mortality trends and real-world outcomes are important for monitoring acute myocardial infarction (AMI) care, although there is limited data beyond 1-year post incident AMI. Methods We used Clinical Practice Research Datalink Aurum to identify patients ≥ 35 with incident AMI between 1 Jan 2006 to 31 Dec 2014. Data was also extracted from three other sources. Risk of all-cause and cardiovascular (CV)-related mortality, incident heart failure (HF), recurrent AMI, and cerebrovascular accidents (CVA) were calculated at 1- and 5-years using regression analysis—2006 was the comparator. Results We identified 94,241 patients with AMI. The 1-year risk for multiple outcomes fell by 2014, including all-cause mortality (hazard ratio (HR): 0.82, 95% CI: 0.75-0.90), CV-related mortality (HR: 0.69, 95% CI: 0.60-0.78), and recurrent AMI (HR 0.72, 95% CI: 0.66-0.79). The 1-year risk for incident HF increased (HR: 1.18, 95% CI: 1.08-1.28) whilst CVA risk did not change (HR: 1.11, 95% CI: 0.98-1.26). At 5-years, the risk fell for all-cause mortality (HR: 0.82, 95% CI: 0.79-0.87), CV-related mortality (HR: 0.68, 95% CI: 0.62-0.74), and recurrent AMI (HR: 0.71, 95% CI: 0.65-0.75) by 2014. The 5-year risk for incident HF increased (HR: 1.15, 95% CI: 1.08-1.23), whilst CVA risk also increased significantly (HR: 1.16, 95% CI: 1.07-1.26) by 2014. Conclusions Across 2006-2014, we observed a falling risk of all-cause mortality, CV-related mortality, and recurrent AMI at 1- and 5-years post incident AMI. Countervailing trends were seen for incident HF, where the risk for CVA also increased significantly by 5-years. Graphical Abstract