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Predictors of Ten-Year Event-Free Survival in Patients With Acute Myocardial Infarction (from the Adria, Bassano, Conegliano, and Padova Hospitals [ABC] Study on Myocardial Infarction)

Published:January 05, 2012DOI:https://doi.org/10.1016/j.amjcard.2011.11.026
      The long-term event-free survival (EFS) after acute myocardial infarction (AMI) is largely uninvestigated. We analyzed noninvasive clinical variables in association with long-term EFS after AMI. The present prospective study included 504 consecutive patients with AMI at 3 hospitals from 1995 to 1998 (Adria, Bassano, Conegliano, and Padova Hospitals [ABC] study). Thirty-seven variables were examined, including demographics, cardiovascular risk factors, in-hospital characteristics, and blood components. The end point was 10-year EFS. Logistic and Cox regression models were used to identify the predictive factors. We compared 3 predictive models according to the goodness of fit and C-statistic analyses. At enrollment, the median age was 67 years (interquartile range 58 to 75), 29% were women, 38% had Killip class >1, and the median left ventricular ejection fraction was 51% (interquartile range 43% to 60%). The 10-year EFS rate was 19%. Both logistic and Cox analyses identified independent predictors, including young age (hazard ratio 1.2, 95% confidence interval 1.1 to 1.3, p = 0.0006), no history of angina (hazard ratio 1.4, 95% confidence interval 1.1 to 1.8, p = 0.009), no previous myocardial infarction (hazard ratio 1.4, 95% confidence interval 1.1 to 1.7, p = 0.01), high estimated glomerular filtration rate (hazard ratio 0.8, 95% confidence interval 0.7 to 0.9, p = 0.001), low albumin/creatinine excretion ratio (hazard ratio 1.2, 95% confidence interval 1.1 to 1.3, p <0.0001), and high left ventricular ejection fraction (hazard ratio 0.8, 95% confidence interval 0.7 to 0.9, p = 0.006). These variables had greater predictive power and improved the predictive power of 2 other models, including Framingham cardiovascular risk factors and the recognized predictors of acute heart damage. In conclusion, 10-year EFS was strongly associated with 4 factors (ABC model) typically neglected in studies of AMI survival, including estimated glomerular filtration rate, albumin/creatinine excretion ratio, a history of angina, and previous myocardial infarction. This model had greater predictive power and improved the power of 2 other models using traditional cardiovascular risk factors and indicators of heart damage during AMI.
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      References

        • Bueno H.
        • Armstrong P.W.
        • Buxton M.J.
        • Danchin N.
        • Lubsen J.
        • Roland E.
        • Verheugt F.W.
        • Zalewski A.
        • Jackson N.
        • Komajda M.
        • Steg P.G.
        • Cardiovascular Round Table Clinical Trials ThinkTank Participants
        The future of clinical trials in secondary prevention after acute coronary syndromes.
        Eur Heart J. 2011; 32: 1583-1589
        • Fox K.A.
        • Carruthers K.F.
        • Dunbar D.R.
        • Graham C.
        • Manning J.R.
        • De Raedt H.
        • Buysschaert I.
        • Lambrechts D.
        • Van de Werf F.
        Underestimated and under-recognized: the late consequences of acute coronary syndrome (GRACE UK-Belgian study).
        Eur Heart J. 2010; 31: 2755-2764
        • Nikus K.C.
        • Eskola M.J.
        • Virtanen V.K.
        • Harju J.
        • Huhtala H.
        • Mikkelsson J.
        • Karhunen P.J.
        • Niemelä K.O.
        Mortality of patients with acute coronary syndromes still remains high: a follow-up study of 1188 consecutive patients admitted to a university hospital.
        Ann Med. 2007; 39: 63-71
        • Halon D.A.
        • Rennert H.S.
        • Flugelman M.Y.
        • Jaffe R.
        • Lewis B.S.
        Burden of late repeat hospitalization in patients undergoing angioplasty or bypass surgery: a long-term (13 years) report from the Lady Davis Carmel Medical Center registry.
        Cardiology. 2002; 98: 67-74
        • Nordestgaard B.G.
        Does elevated C-reactive protein cause human atherothrombosis?.
        Curr Opin Lipidol. 2009; 20: 393-401
        • Brieger D.
        • Fox K.A.
        • Fitzgerald G.
        • Eagle K.A.
        • Budaj A.
        • Avezum A.
        • Granger C.B.
        • Costa B.
        • Anderson Jr, F.A.
        • Steg P.G.
        • Global Registry of Acute Coronary Events Investigators
        predicting freedom from clinical events in non-ST-elevation acute coronary syndromes: the Global Registry of Acute Coronary Events.
        Heart. 2009; 95: 888-894
        • Brzostek T.
        • Van de Werf F.
        • Scheys I.
        • Lesaffre E.
        • Dubiel J.
        • De Geest H.
        Prediction of event-free survival after hospital discharge in acute myocardial infarction treated with tissue-plasminogen activator.
        Acta Cardiol. 1994; 49: 9-24
        • Halon D.A.
        • Merdler A.
        • Flugelman M.Y.
        • Shifroni G.
        • Khader N.
        • Shiran A.
        • Shahla J.
        • Lewis B.S.
        importance of diabetes mellitus and systemic hypertension rather than completeness of revascularization in determining long-term outcome after coronary balloon angioplasty (the LDCMC registry).
        Am J Cardiol. 1998; 82: 547-553
        • Berton G.
        • Citro T.
        • Palmieri R.
        • Petucco S.
        • De Toni R.
        • Palatini P.
        Albumin excretion rate increases during acute myocardial infarction and strongly predicts early mortality.
        Circulation. 1997; 96: 3338-3345
        • Erbel R.
        • Krebs W.
        • Henn G.
        • Schweizer P.
        • Richter H.A.
        • Meyer J.
        • Effert S.
        Comparison of single-plane and biplane volume determination by two-dimensional echocardiography: 1.
        Eur Heart J. 1982; 3: 469-474
        • Levey A.S.
        • Bosch J.P.
        • Lewis J.B.
        • Greene T.
        • Rogers N.
        • Roth D.
        A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation.
        Ann Intern Med. 1999; 130: 461-470
        • Jensen J.S.
        • Clausen P.
        • Borch-Johnsen K.
        • Jensen G.
        • Feldt-Rasmussen B.
        Detecting microalbuminuria by urinary albumin/creatinine concentration ratio.
        Nephrol Dial Trasplant. 1997; 12S2: 6-9
        • Annesi I.
        • Moreau T.
        • Lellouch J.
        Efficiency of the logistic regression and Cox proportional hazards models in longitudinal studies.
        Stat Med. 1989; 8: 1515-1521
        • Mark D.B.
        • Nelson C.L.
        • Califf R.M.
        • Harrell F.E.
        • Lee K.L.
        • Jones R.H.
        • Fortin D.F.
        • Stack R.S.
        • Glower D.D.
        • Smith L.R.
        • DeLong E.R.
        • Smith P.K.
        • Reves J.G.
        • Jollis J.G.
        • Tcheng J.E.
        • Muhlbaier L.H.
        • Lowe J.E.
        • Phillips H.R.
        • Pryor D.B.
        Continuing evolution of therapy for coronary artery disease.
        Circulation. 1994; 89: 2015-2025
        • Moss M.
        • Wellman D.A.
        • Cotsonis G.A.
        An appraisal of multivariable logistic models in the pulmonary and critical care literature.
        Chest. 2003; 123: 923-928
        • Grunkemeier G.L.
        • Jin R.
        Receiver operating characteristic curve analysis of clinical risk models.
        J Thorac Surg. 2001; 72: 323-326
        • Hosmer D.W.
        • Lemeshow S.
        A goodness-of-fit test for the multiple logistic regression model.
        Stat. 1980; 10: 1043-1069
        • Lee G.K.
        • Lee L.C.
        • Liu C.W.
        • Lim S.L.
        • Shi L.M.
        • Ong H.Y.
        • Lim Y.T.
        • Yeo T.C.
        Framingham risk score inadequately predicts cardiac risk in young patients presenting with a first myocardial infarction.
        Ann Acad Med Singapore. 2010; 39: 163-637
        • Ruygrok P.N.
        • de Jaegere P.T.
        • van Domburg R.T.
        • van den Brand M.J.
        • Serruys P.W.
        • de Feyter P.J.
        Clinical outcome 10 years after attempted percutaneous transluminal coronary angioplasty in 856 patients.
        J Am Coll Cardiol. 1996; 27: 1669-1677
        • Brown K.A.
        • Weiss R.M.
        • Clements J.P.
        • Wackers F.J.
        Usefulness of residual ischemic myocardium within prior infarct zone for identifying patients at high risk late after acute myocardial infarction.
        Am J Cardiol. 1987; 60: 15-19
        • Berning J.
        • Steensgaard-Hansen F.V.
        • Appleyard M.
        prognostication in acute myocardial infarction by early echocardiographic estimation of left ventricular ejection fraction: multivariate statistical comparison with a clinical prognostic index and its components.
        Dan Med Bull. 1992; 39: 177-181
        • Mueller H.S.
        • Forman S.A.
        • Menegus M.A.
        • Cohen L.S.
        • Knatterud G.L.
        • Braunwald E.
        • The TIMI Investigators
        Prognostic significance of nonfatal reinfarction during 3-year follow-up: results of the Thrombolysis In Myocardial Infarction (TIMI) phase II clinical trial.
        J Am Coll Cardiol. 1995; 26: 900-907
        • Schiele F.
        • Meneveau N.
        • Chopard R.
        • Descotes-Genon V.
        • Oettinger J.
        • Seronde M.F.
        • Briand F.
        • Bernard Y.
        • Ecarnot F.
        • Bassand J.P.
        • de Cardiologie de Franche Comte R.
        Prognostic value of albuminuria on 1-month mortality in acute myocardial infarction.
        Am Heart J. 2009; 157: 327-333
        • Koulouris S.
        • Lekatsas I.
        • Karabinos I.
        • Ioannidis G.
        • Katostaras T.
        • Kranidis A.
        • Triantafillou K.
        • Thalassinos N.
        • Anthopoulos L.
        Microalbuminuria: a strong predictor of 3-year adverse prognosis in nondiabetic patients with acute myocardial infarction.
        Am Heart J. 2005; 149: 840-845
        • Berton G.
        • Cordiano R.
        • Mazzuco S.
        • Katz E.
        • De Toni R.
        • Palatini P.
        albumin excretion in acute myocardial infarction: a guide for long-term prognosis.
        Am Heart J. 2008; 156: 760-768
        • Stehouwer C.D.
        • Nauta J.J.
        • Zeldenrust G.C.
        • Hackeng W.H.
        • Donker A.J.
        • den Ottolander G.J.
        Urinary albumin excretion, cardiovascular disease, and endothelial dysfunction in non-insulin-dependent diabetes mellitus.
        Lancet. 1992; 340: 319-323
        • Naidoo D.P.
        The link between microalbuminuria, endothelial dysfunction and cardiovascular disease in diabetes.
        Cardiovasc J S Afr. 2002; 13: 194-199
        • Gibson C.M.
        • Pinto D.S.
        • Murphy S.A.
        • Morrow D.A.
        • Hobbach H.P.
        • Wiviott S.D.
        • Giugliano R.P.
        • Cannon C.P.
        • Antman E.M.
        • Braunwald E.
        • TIMI Study Group
        Association of creatinine and creatinine clearance on presentation in acute myocardial infarction with subsequent mortality.
        J Am Coll Cardiol. 2003; 42: 1535-1543
        • Palmer S.C.
        • Yandle T.G.
        • Frampton C.M.
        • Troughton R.W.
        • Nicholls M.G.
        • Richards A.M.
        Renal and cardiac function for long-term (10 year) risk stratification after myocardial infarction.
        Eur Heart J. 2009; 12: 1486-1494