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Int J Cardiol. 2019 Dec 1;296:8-14. doi: 10.1016/j.ijcard.2019.06.040. Epub 2019 Jun 20.

Managed Care after Acute Myocardial Infarction (MC-AMI) - a Poland's nationwide program of comprehensive post-MI care - improves prognosis in 12-month follow-up. Preliminary experience from a single high-volume center.

Author information

1
First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
2
Department of Cardiology, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland. Electronic address: andrzejkulach@gmail.com.
3
Department of Cardiology, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland.
4
Third Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
5
Daily Cardiology Rehabilitation Department, Upper Silesian Medical Center in Katowice, Katowice, Poland.

Abstract

BACKGROUND:

Despite progress in the treatment of acute myocardial infarction (AMI), long-term prognosis in MI survivors remains a challenge. The Managed Care in Acute Myocardial Infarction (MC-AMI, KOS-zawal) is the first program of a comprehensive, supervised care for patients with AMI to improve long-term prognosis. It includes acute intervention, complex revascularization, cardiac rehabilitation (CR), outpatient follow-up, and prevention of SCD. Our aim was to assess the relation between participation in MC-AMI and major adverse cardiovascular and cerebrovascular events (MACCE) in 12-month follow-up.

METHODS AND RESULTS:

In this single-center, retrospective analysis we compared 719 patients participating in MC-AMI and compared them to 1130 subjects in the control group. After propensity score matching, two groups of 529 subjects each were compared. MC-AMI was related with MACCE reduction by 40% in a 12-month observation. Participants of MC-AMI had a higher adherence to cardiac rehabilitation (98 vs. 14%), higher rate of scheduled revascularisation (coronary artery bypass grafting: 9.8% vs. 4.9%, p ≪ 0.001; elective percutaneous coronary intervention: 3.0% vs 2.1%, p ≪ 0.05) and ICD implantation (2.8% vs. 0.6%, p ≪ 0.05) compared to control. Multivariable Cox regression analysis revealed MC-AMI to be inversely associated with the occurrence of MACCE (HR = 0.500, 95% Cl 0.349-0.718, p ≪ 0.001). Besides, older age, diabetes mellitus, hyperlipidemia, prior PAD, previous UA, and lower LVEF were significantly associated with the primary endpoint.

CONCLUSIONS:

MC-AMI is the first program of comprehensive care for AMI patients. MC-AMI improves prognosis by increasing the rate of patients undergoing CR, complete revascularization and ICD implantation, thus reducing MACCE.

KEYWORDS:

Cardiac rehabilitation; Cardiovascular prevention; MACCE; MC-AMI; Myocardial infarction; Post MI prognosis

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