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Association of Unrecognized Myocardial Infarction With Long-term Outcomes in Community-Dwelling Older Adults
https://jamanetwork.com/journals/jamacardiology/fullarticle/2705678
Of 935 participants, 452 (48.3%) were men; the mean (SD) age of participants with no MI, UMI, and RMI was 75.6 (5.3) years, 76.8 (5.2) years, and 76.8 (4.7) years, respectively. At 3 years, UMI and no #MI mortality rates were similar (3%) and lower than RMI rates (9%). At 5 years, UMI mortality rates (13%) increased and were higher than no MI rates (8%) but still lower than RMI rates (19%). By 10 years, UMI and RMI mortality rates (49% and 51%, respectively) were not statistically different; both were significantly higher than no MI (30%) (P < .001). After adjusting for age, sex, and diabetes, UMI by CMR had an increased risk of death (hazard ratio [HR], 1.61; 95% CI, 1.27-2.04), MACE (HR, 1.56; 95% CI, 1.26-1.93), MI (HR, 2.09; 95% CI, 1.45-3.03), and heart failure (HR, 1.52; 95% CI, 1.09-2.14) compared with no MI and statistically nondifferent risk of death (HR, 0.99; 95% CI, 0.71-1.38) and MACE (HR, 1.23; 95% CI, 0.91-1.66) vs RMI.
Conclusions and Relevance In this study, all-cause mortality of UMI was higher than no MI, but within 10 years from baseline evaluation was equivalent with RMI. Unrecognized MI was also associated with an elevated risk of nonfatal MI and heart #failure. Whether secondary prevention can alter the prognosis of UMI will require prospective testing.
Association of Unrecognized Myocardial Infarction With Long-term Outcomes in Community-Dwelling Older Adults
https://jamanetwork.com/journals/jamacardiology/fullarticle/2705678
Of 935 participants, 452 (48.3%) were men; the mean (SD) age of participants with no MI, UMI, and RMI was 75.6 (5.3) years, 76.8 (5.2) years, and 76.8 (4.7) years, respectively. At 3 years, UMI and no #MI mortality rates were similar (3%) and lower than RMI rates (9%). At 5 years, UMI mortality rates (13%) increased and were higher than no MI rates (8%) but still lower than RMI rates (19%). By 10 years, UMI and RMI mortality rates (49% and 51%, respectively) were not statistically different; both were significantly higher than no MI (30%) (P < .001). After adjusting for age, sex, and diabetes, UMI by CMR had an increased risk of death (hazard ratio [HR], 1.61; 95% CI, 1.27-2.04), MACE (HR, 1.56; 95% CI, 1.26-1.93), MI (HR, 2.09; 95% CI, 1.45-3.03), and heart failure (HR, 1.52; 95% CI, 1.09-2.14) compared with no MI and statistically nondifferent risk of death (HR, 0.99; 95% CI, 0.71-1.38) and MACE (HR, 1.23; 95% CI, 0.91-1.66) vs RMI.
Conclusions and Relevance In this study, all-cause mortality of UMI was higher than no MI, but within 10 years from baseline evaluation was equivalent with RMI. Unrecognized MI was also associated with an elevated risk of nonfatal MI and heart #failure. Whether secondary prevention can alter the prognosis of UMI will require prospective testing.
Jamanetwork
Association of Unrecognized Myocardial Infarction With Long-term Outcomes in Community-Dwelling Older Adults
This cohort study of community-dwelling, elderly individuals in Iceland examines the association of unrecognized myocardial infarction by cardiovascular magnetic resonance imaging with major adverse cardiac events, such as death, nonfatal myocardial infarction…
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#Statins After Myocardial Infarction in the Oldest: A Cohort Study in the Clinical Practice Research Datalink Database
Among the 3900 patients aged 80 years and older, 2 years of statin prescriptions resulted in a lower risk of the composite outcome (adjusted HR = 0.81; 95% confidence interval [CI] = 0.66‐0.99) and of all‐cause mortality (adjusted HR = 0.84; 95% CI = 0.73‐0.97). During 4.5 years of median follow‐up, the NNT for prevention of the primary outcome was 59; and for mortality, the NNT was 36. Correcting for 36.2% deaths during the first 2 years increased the NNT on the primary outcome to 93 and to 61 on all‐cause mortality.
CONCLUSION
Our data support statin initiation after a first #MI in patients aged 80 years and older if continued for at least 2 years. Especially in patients with a low risk of 2‐year mortality, statins should be considered.
https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.16227
#Statins After Myocardial Infarction in the Oldest: A Cohort Study in the Clinical Practice Research Datalink Database
Among the 3900 patients aged 80 years and older, 2 years of statin prescriptions resulted in a lower risk of the composite outcome (adjusted HR = 0.81; 95% confidence interval [CI] = 0.66‐0.99) and of all‐cause mortality (adjusted HR = 0.84; 95% CI = 0.73‐0.97). During 4.5 years of median follow‐up, the NNT for prevention of the primary outcome was 59; and for mortality, the NNT was 36. Correcting for 36.2% deaths during the first 2 years increased the NNT on the primary outcome to 93 and to 61 on all‐cause mortality.
CONCLUSION
Our data support statin initiation after a first #MI in patients aged 80 years and older if continued for at least 2 years. Especially in patients with a low risk of 2‐year mortality, statins should be considered.
https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.16227
Wiley Online Library
Statins After Myocardial Infarction in the Oldest: A Cohort Study in the Clinical Practice Research Datalink Database
OBJECTIVE
To explore the effect of initiating statins for secondary prevention after a first myocardial infarction (MI) in patients aged 80 years and older.
DESIGN
Retrospective cohort study.
SE...
To explore the effect of initiating statins for secondary prevention after a first myocardial infarction (MI) in patients aged 80 years and older.
DESIGN
Retrospective cohort study.
SE...