Secondary prevention strategies after an acute ST-segment elevation myocardial infarction in the AMI code era : beyond myocardial mechanical reperfusion
Ribas-Barquet, Núria (Hospital del Mar (Barcelona, Catalunya))
Garcia Garcia, Cosme (Hospital del Mar (Barcelona, Catalunya))
Meroño, Oona (Hospital del Mar (Barcelona, Catalunya))
Recasens, Lluís (Hospital del Mar (Barcelona, Catalunya))
Pérez-Fernández, Silvia (Institut Hospital del Mar d'Investigacions Mèdiques)
Bazán, Víctor (Hospital del Mar (Barcelona, Catalunya))
Salvatella, Neus (Hospital del Mar (Barcelona, Catalunya))
Martí-Almor, Julio (Hospital del Mar (Barcelona, Catalunya))
Bruguera Cortada, Jordi (Hospital del Mar (Barcelona, Catalunya))
Elosua, Roberto (Institut Hospital del Mar d'Investigacions Mèdiques)
Universitat Autònoma de Barcelona

Data:	2017
Resum:	The AMI code is a regional network enhancing a rapid and widespread access to reperfusion therapy (giving priority to primary angioplasty) in patients with acute ST-segment elevation myocardial infarction (STEMI). We aimed to assess the long-term control of conventional cardiovascular risk factors after a STEMI among patients included in the AMI code registry. Four hundred and fifty-four patients were prospectively included between June-2009 and April-2013. Clinical characteristics were collected at baseline. The long-term control of cardiovascular risk factors and cardiovascular morbidity/mortality was assessed among the 6-months survivors. A total of 423 patients overcame the first 6 months after the STEMI episode, of whom 370 (87%) underwent reperfusion therapy (363, 98% of them, with primary angioplasty). At 1-year follow-up, only 263 (62%) had adequate blood pressure control, 123 (29%) had LDL-cholesterol within targeted levels, 126/210 (60%) smokers had withdrawn from their habit and 40/112 (36%) diabetic patients had adequate glycosylated hemoglobin levels. During a median follow-up of 20 (11-30) months, cumulative mortality of 6 month-survivors was 6. 1%, with 9. 9% of hospital cardiovascular readmissions. The lack of assessment of LDL and HDL-cholesterol were significantly associated with higher mortality and cardiovascular readmission rates. Whereas implementation of the AMI code resulted in a widespread access to rapid reperfusion therapy, its long-term therapeutic benefit may be partially counterbalanced by a manifestly suboptimal control of cardiovascular risk factors. Further efforts should be devoted to secondary prevention strategies after STEMI. The online version of this article (doi:10. 1186/s12872-017-0493-6) contains supplementary material, which is available to authorized users.
Ajuts:	Instituto de Salud Carlos III HERACLES-RD12-0042-0013
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	ST-segment elevation myocardial infarction ; Coronary angioplasty ; Secondary prevention ; Prognosis ; Reperfusion therapy ; Cardiovascular risk factors
Publicat a:	BMC Cardiovascular disorders, Vol. 17 (february 2017) , ISSN 1471-2261

DOI: 10.1186/s12872-017-0493-6
PMID: 28173757

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