Patients with a history of myocardial infarction are at significantly increased risk of recurrent cardiovascular events. Despite established clinical guidelines, secondary preventive care is often initiated too late, inadequate in intensity or incomplete in application. As a result, important opportunities to prevent serious outcomes are missed.
The aim of this project is to investigate whether rapid, guideline-based treatment following myocardial infarction leads to improved patient outcomes. The study protocol is based on current clinical guidelines and targets key domains including diabetes, hypertension, and hypercholesterolemia. Outcomes of patients treated according to the study protocol will be compared to those receiving standard care. Primary endpoints include major adverse cardiac- and cerebrovascular events within a 24-month follow-up period.
The investigators hypothesize that rapid, guideline-based intervention will result in improved risk factor management, leading to a reduction in cardiovascular events and mortality. For patients, this may translate into improved health, quality of life and life expectancy. This project aims to deliver a practical protocol for effective secondary prevention in clinical practice, which is expected to reduce healthcare utilization in the long term. With this initiative, the investigators seek to take a significant step toward improving post-myocardial infarction care and contributing to sustainable cardiovascular healthcare.
Age > 18 years
Hospitalised with acute coronary syndrome
Underwent percutaneous coronary intervention
Acute coronary syndrome secondary to other diseases
Life expectancy < 1 year based on the clinician's expertise
The study population consists of patients, hospitalised in Zuyderland, who underwent a percutaneous coronary intervention due to an acute coronary syndrome (unstable angina (UA), ST-elevation myocardial infarction (STEMI), or non ST-elevation myocardial infarction (non-STEMI)).
Cohort
Prospective
Rapid ESC-guideline based secondary prevention following myocardial infaction
DrugIn the intervention group, patients will be treated according to a rapid ESC-guideline-based protocol. This approach will target: 1\. Optimal pharmacological treatment, including: * Lipid-lowering * Antihypertensive * Diabetic, such sodium-glucose co-transporter 2 inhibitors (SGLT-2 inhibitors) * Glucagon-like peptide-1 agonists (GLP-1 agonists)
MACCE within 2 years after the ACS and PCI
The occurrence of major adverse cardiac- and cerebrovascular events (MACCE) defined as the composite of all cause death, myocardial infarction, (ischemic or hemorrhagic) CVA, and ischemia-driven revascularization at 24 months.
30 days endpoints checklist
Prevelance of the following endpoints with 30 days after discharge: * Death due to any cause * Cardiovascular mortality * Reacurent acute coronary syndrom * Ischemia-driven revascularization * Ischemic CVA * Haemorrhagic CVA * Uplanned cardiovascular hospital readmission * New onset of diabetes mellitus type 2 * New onset of peripheral arterial disease * Sustained decline of eGFR of 50% for more than 3 months based on eGFR lab value Measures will be defined as either present or absent and collected via medical record.
Quality of life survey at 30 days
Patients recieve a quality of life survey at 30 days after discharge. This is done with a SF-36 questionnaire
1 year endpoints checklist
Prevelance of the following endpoints 1 year after discharge: * Death due to any cause * Cardiovascular mortality * Reacurent acute coronary syndrom * Ischemia-driven revascularization * Ischemic CVA * Haemorrhagic CVA * Uplanned cardiovascular hospital readmission * New onset of diabetes mellitus type 2 * New onset of peripheral arterial disease * Sustained decline of eGFR of 50% for more than 3 months Measures will be defined as either present or absent and collected via medical record.
Quality of life survey at 1year
Patients recieve a quality of life survey at 1year after discharge. This is done with a SF-36 questionnaire
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