Registry data: Death most common subsequent event after index CV event
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Registry data from Finland show a rapid increase of recurrent CV events and deaths within the first 6 months of an index CV event, underscoring the need for comprehensive secondary prevention, researchers reported.
More than 40% of patients had a second CV event within 5 years of their first one, and among those second events, death was the most common, according to the researchers.
“Large numbers of patients are living with CV diseases and thus are at risk of having a CV event,” Iiro Toppila, MSc, a data analysis lead and biostatistician at Medaffcon Oy in Espoo, Finland, and colleagues wrote in the study background. “Further, survivors of each CV event are at risk of a more severe recurrent event. A nationwide Swedish registry study showed that, of patients with an MI, 18.3% had a recurrent MI, stroke or CV death during the following year. In addition, data obtained from post-ACS patients reported that 9.2% of the patients experienced a CV event during a median follow‐up of 1 year. Additionally, approximately one‐third of the patients experienced a second CV event, which was typically soon after the first.”
Risk for recurrence
In a retrospective registry study, Toppila and colleagues analyzed data from 48,405 patients with an incident atherosclerotic CV event from 2012 to 2016 who were followed for a mean of 2.2 years for recurrent CV events or death, using data from three Finland university hospitals. The median age of patients was 72 years and 54% were men; women were on average 6.5 years older at the index CV event. Researchers assessed the risk and risk factors for recurrent CV events or death and time from the first CV event to recurrence.
The findings were published in Clinical Cardiology.
Within the cohort, 40.1% experienced ischemic stroke, 29.4% had an MI, 19.5% had a transient ischemic attack and 11.1% had unstable angina as the index CV event. The event rate was 14.34 events per 100 patient‐years. Models suggested that at 5 years after the index CV event, 41.5% of the patients had died or experienced a recurrent CV event. Death was the most common type of subsequent event (61.5%), followed most by another event of the same type.
“In addition, the cardiac (MI and unstable angina) and cerebrovascular (ischemic stroke and TIA) events showed clustering (ie, a cardiac event was more frequently followed by another cardiac event and correspondingly for cerebrovascular events),” the researchers wrote. “However, there was also a notable number of events that were followed by a recurrent event of another type.”
After the index event, there were rapid increases in recurrent events and deaths during the next 6 months. After 180 days, 14% of the patients experienced a recurrent CV event or had died of any cause.
“After the initial surge, the occurrence of both CV event recurrence and deaths stabilized to a relatively constant rate,” the researchers wrote.
Importance of secondary prevention
The researchers noted the findings highlight the importance of efficient secondary prevention measures and risk stratification early after a CV event to reduce the risk for subsequent events and to improve patient health outcomes.
The findings “suggest that the acute treatment of the index event should be followed by prompt secondary prevention measures to achieve guideline‐recommended goals as soon as possible,” the researchers wrote.
As Healio previously reported, data from a meta-analysis of large phase 3 trials show the initial 90‐day window after ACS represents a vulnerable period for recurrent events, possibly attributable to atherothrombosis mechanisms not currently addressed with optimal therapy.
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