Secondary prevention strategies after an acute ST-segment elevation myocardial infarction in the AMI code era : beyond myocardial mechanical reperfusion
Ribas, 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had adequate blood pressure control, 123 (29%) had LDL-cholesterol within targeted levels, 126/210 (60%) smokers had withdrawn from their habit and 40/112 (36%) diabetic patients had adequate glycosylated hemoglobin levels.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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