The Prognostic Impact of Multiple Adverse Events on Long‐Term Mortality Following Acute Myocardial Infarction
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Adverse events after acute myocardial infarction (AMI) are individually associated with poor outcomes, but the prognostic impact of the overlap of different event types occurring sequentially within the same patient remains uncertain. AIMS: Mortality associated with multiple events-defined as ≥ 2 different event types among spontaneous myocardial infarction (MI), ischemic stroke, and major bleeding-was compared with single events after AMI. METHODS: We analyzed 10,719 AMI patients in the multicenter Korean AMI registry. Patients contributed person-time to mutually exclusive, time-varying states: no event; MI only; stroke only; Bleeding Academic Research Consortium (BARC) type 3 bleeding only; and multiple events (≥ 2 different types). Mortality was modeled using multivariable Cox regression with stabilized inverse-probability weighting (IPW) and piecewise intervals for early (≤ 30 days), intermediate (30 days to 1 year), and late (>1 year) risk. RESULTS: Over a median 4.9 years, 2625 patients died. Multiple events occurred in 108 patients (1.0%): MI + bleeding (55%), stroke+bleeding (31%), and MI + stroke (15%). Mortality patterns were consistent across multiple-event combinations. Multiple events conferred the highest risk of death (5-year IPW-adjusted hazard ratio [HR]: 5.85, 95% confidence interval [CI]: 3.48-9.85), exceeding MI only (HR: 3.78), stroke only (HR: 2.72), or bleeding only (HR: 3.08). Mortality was most pronounced within 30 days, most markedly after multiple events (IPW-adjusted HR: 24.0, 95% CI: 12.9-44.7). CONCLUSIONS: Multiple adverse events after AMI confer substantially higher mortality risk than single events, with the greatest impact in the first 30 days. These findings support the need for an immediate and tailored approach and sustained surveillance to prevent further ischemic or bleeding complications.
DOI: 10.1002/ccd.70521
Institutions: The Catholic University of Korea Incheon St. Mary's Hospital, Catholic University of Korea, The Catholic University of Korea Daejeon St. Mary's Hospital, The Catholic University of Korea Seoul St. Mary's Hospital, The Catholic University of Korea Uijeongbu St. Mary's Hospital, The Catholic University of Korea St. Vincent's Hospital, The Catholic University of Korea Yeouido St. Mary's Hospital, The Catholic University of Korea Bucheon St. Mary's Hospital, Chonnam National University
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,490
OpenAlex ID: W7130507348