6 Gilpin E, Ricou F, Dittrich H, Nicod P, Henning H, Ross J Jr. Fac- tors associated with ... ted to a hospital without PTCA facilities: a safety and feasibility study.
ORIGINAL ARTICLE
Prognostic significance of nonfatal
myocardial reinfarction in survivors of a first infarction RT. van Domburg, J.W. Deckers, P.F.M.M. van Bergen, A.J. Azar, J.J.C. Jonker, M.L. Simoons
Background. Patients who develop a reinfarction are at increased risk for subsequent reinfarctions and death. However, follow-up studies in these patients are rare. Objective. The purpose of this study was to exanine the risk of mortality after a first myocardial reinfarction and to determine the independent contribution of nonfatal reinfarction to the risk of subsequent mortality. Methods. The prognostic value of nonfatal reinfarction was assessed in a large series (n=3097) of patients with a first myocardial infarction who participated in the ASPECT trial, comparing coumarin or matching placebo. Results. A second myocardial infarction was documented in 299 patients (82% Q-wave infarctions), 45 (15%) of which were fatal. Of the 254 nonfatal reinfarctions, 31 patients (12%) died during subsequent follow-up. After adjustment for baseline characteristics, the relative risks of nonfatal reinfarction for subsequent cardiac mortality at one month were: 2.90 (1.49- 5.64), at one year: 2.50 (1.47-4.23) and at three years: 2.71 (1.77-4.17). Rates of death or a second reinfarction in patients who did not undergo a revascularisation procedure after a first reinfarction were almost three times higher than in patients who did have PTCA or bypass surgery after a reinfarction (38% versus 14%; p
