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

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 c...

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Autores principales: Herrett, Emily, Bhaskaran, Krishnan, Timmis, Adam, Denaxas, Spiros, Hemingway, Harry, Smeeth, Liam
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4163194/
https://www.ncbi.nlm.nih.gov/pubmed/25038774
http://dx.doi.org/10.1093/eurheartj/ehu286
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author Herrett, Emily
Bhaskaran, Krishnan
Timmis, Adam
Denaxas, Spiros
Hemingway, Harry
Smeeth, Liam
author_facet Herrett, Emily
Bhaskaran, Krishnan
Timmis, Adam
Denaxas, Spiros
Hemingway, Harry
Smeeth, Liam
author_sort Herrett, Emily
collection PubMed
description 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. 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). 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. CLINICAL TRIALS REGISTRATION: Clinicaltrials.gov identifier NCT01604486.
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spelling pubmed-41631942014-09-15 Association between clinical presentations before myocardial infarction and coronary mortality: a prospective population-based study using linked electronic records Herrett, Emily Bhaskaran, Krishnan Timmis, Adam Denaxas, Spiros Hemingway, Harry Smeeth, Liam Eur Heart J Clinical Research 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. 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). 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. CLINICAL TRIALS REGISTRATION: Clinicaltrials.gov identifier NCT01604486. Oxford University Press 2014-09-14 2014-07-19 /pmc/articles/PMC4163194/ /pubmed/25038774 http://dx.doi.org/10.1093/eurheartj/ehu286 Text en © The Author 2014. Published by Oxford University Press on behalf of the European Society of Cardiology. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Clinical Research
Herrett, Emily
Bhaskaran, Krishnan
Timmis, Adam
Denaxas, Spiros
Hemingway, Harry
Smeeth, Liam
Association between clinical presentations before myocardial infarction and coronary mortality: a prospective population-based study using linked electronic records
title Association between clinical presentations before myocardial infarction and coronary mortality: a prospective population-based study using linked electronic records
title_full Association between clinical presentations before myocardial infarction and coronary mortality: a prospective population-based study using linked electronic records
title_fullStr Association between clinical presentations before myocardial infarction and coronary mortality: a prospective population-based study using linked electronic records
title_full_unstemmed Association between clinical presentations before myocardial infarction and coronary mortality: a prospective population-based study using linked electronic records
title_short Association between clinical presentations before myocardial infarction and coronary mortality: a prospective population-based study using linked electronic records
title_sort association between clinical presentations before myocardial infarction and coronary mortality: a prospective population-based study using linked electronic records
topic Clinical Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4163194/
https://www.ncbi.nlm.nih.gov/pubmed/25038774
http://dx.doi.org/10.1093/eurheartj/ehu286
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