Residual Risk for Coronary Heart Disease Events and Mortality Despite Intensive Medical Management Following Myocardial Infarction

Abstract Background High-intensity statins, beta-blockers, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and antiplatelet agents (i.e. intensive medical management) reduce coronary heart disease (CHD) risk following myocardial infarction (MI). Objective Determine the risk of CHD events or death despite receiving intensive medical management following MI. Methods We studied 16,853 US adults with health insurance in the MarketScan and Medicare databases who underwent percutaneous coronary intervention while hospitalized for MI between January 1, 2014 and June 30, 2015 and received intensive medical management within 30 days following hospital discharge. MI, CHD, and all-cause mortality rates from 30 days after hospital discharge through December 31, 2015 were compared to 67,412 individuals in each of three groups: (1) the general MarketScan and Medicare populations, (2) with diabetes, and (3) with a CHD history. Results Among beneficiaries intensively medically managed after their MI, recurrent MI, CHD events, and all-cause mortality rates were 47.1, 72.0, and 57.5 per 1,000 person-years, respectively. The multivariable-adjusted hazard ratio (95% CI) comparing intensively medically managed beneficiaries following MI to the general population, those with diabetes, and those with a history of CHD were 8.54 (7.52-9.70), 7.40 (6.61-8.28) and 5.45 (4.92-6.05), respectively, for recurrent MI; 7.82 (7.07-8.64), 6.27 (5.74-6.86), and 4.45 (4.10-4.82), respectively, for CHD events; and 1.15 (1.05-1.25), 1.05 (0.97-1.14), and 1.06 (0.97-1.15), respectively, for all-cause mortality. Conclusion Substantial residual risk for MI and CHD events remains despite intensive medical management following MI.