Association between clinical presentations before myocardial infarction and coronary mortality: a prospective population-based study using linked electronic records.


Herrett, E; Bhaskaran, K; Timmis, A; Denaxas, S; Hemingway, H; Smeeth, L; (2014) Association between clinical presentations before myocardial infarction and coronary mortality: a prospective population-based study using linked electronic records. European heart journal, 35 (35). pp. 2363-71. ISSN 0195-668X DOI: https://doi.org/10.1093/eurheartj/ehu286

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Abstract

BACKGROUND: Ischaemia in different arterial territories before acute myocardial infarction (AMI) may influence post-AMI outcomes. No studies have evaluated prospectively collected information on ischaemia and its effect on short- and long-term coronary mortality. The objective of this study was to compare patients with and without prospectively measured ischaemic presentations before AMI in terms of infarct characteristics and coronary mortality.<br/> METHODS AND RESULTS: As part of the CALIBER programme, we linked data from primary care, hospital admissions, the national acute coronary syndrome registry and cause-specific mortality to identify patients with first AMI (n = 16,439). We analysed time from AMI to coronary mortality (n = 5283 deaths) using Cox regression (median 2.6 years follow-up), comparing patients with and without recent ischaemic presentations. Patients with ischaemic presentations in the 90 days before AMI experienced lower coronary mortality in the first 7 days after AMI compared with those with no prior ischaemic presentations, after adjusting for age, sex, smoking, diabetes, blood pressure and cardiovascular medications [HR: 0.64 (95% CI: 0.57-0.73) P < 0.001], but subsequent mortality was higher [HR: 1.42 (1.13-1.77) P = 0.001]. Patients with ischaemic presentations closer in time to AMI had the lowest seven day mortality (P-trend = 0.001).<br/> CONCLUSION: In the first large prospective study of ischaemic presentations prior to AMI, we have shown that those occurring closest to AMI are associated with lower short-term coronary mortality following AMI, which could represent a natural ischaemic preconditioning effect, observed in a clinical setting.<br/> CLINICAL TRIALS REGISTRATION: Clinicaltrials.gov identifier NCT01604486.<br/>

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Non-Communicable Disease Epidemiology
PubMed ID: 25038774
Web of Science ID: 342234400013
URI: http://researchonline.lshtm.ac.uk/id/eprint/1831388

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