1. Impact of Prior Myocardial Infarction Among Patients with Acute Myocardial Infarction Treated in Contemporary Practice: A Report from the ACTION Registry ® - GWTG TM Lan Shen, MD, Bimal R. Shah, MD, MBA, Aro Nam, BS, DaJuanicia Holmes, MS, Karen P. Alexander, MD, Deepak L. Bhatt, MD, MPH, Michael Ho, MD, Eric D. Peterson, MD, MPH, Matthew T. Roe, MD, MHS Duke Clinical Research Institute, Durham, NC, U.S.A; Shanghai Renji Hospital, Cardiology department, Shanghai, China; VA Boston Healthcare System, Brigham and Women's Hospital, Harvard Medical School; VA Eastern Colorado Healthcare System and University of Colorado Denver BackgroundResults A total of 307,646 consecutive MI patients from the ACTION-GWTG registry from 01/2007-03/2012 were studied. Prior MI is defined as if the patient has had at least one documented previous myocardial infarction at any time between birth and arrival at first facility. Separately for STEMI and NSTEMI patients, baseline characteristics, home medication, and in-hospital mortality rates and in-hospital recurrent MI rates were compared between no prior MI and prior MI patients using the Wilcoxon-rank sum test for continuous variables and the chi-square test for categorical variables. The ACTION-GWTG registry in-hospital mortality model was used for adjustment to compare the in- hospital mortality of no prior MI and prior MI (c=0.84). Methods For more information go to www.ncdr.com or email ncdrresearch@acc.orgwww.ncdr.com Improved cardiac care has reduced the mortality and morbidity of MI, however, recurrent events have remained high in this at-risk population. Patients with prior MI have shown to have more comorbidities and paradoxically are less likely to receive evidence-based medications when they present with a recurrent ischemic event. The prevalence and prognostic impact of prior MI has not been assessed on the outcomes of patients presenting STEMI or NSTEMI based MI classification. Limitation In-hospital treatment Conclusion This research was supported by the American College of Cardiology Foundation’s National Cardiovascular Data Registry (NCDR). The views expressed in this abstract represent those of the author(s), and do not necessarily represent the official views of the NCDR or its associated professional societies identified at www.ncdr.com. STEMINSTEMI n=116331n=191315 No Prior MIPrior MINo Prior MIPrior MI n=94238n=22093n=135609n=55706 Acute Medications Aspirin % 99 97 Thienopyridine % 90895662 GP IIb/IIIa % 63623327 Beta Blocker % 93 8889 Anticoagulants % 96959291 In-hospital procedure Cath % 97958475 PCI % 87865044 CABG % 76138 Numbers represent percentages unless noted other wise. Centers voluntarily participate in the ACTION registry. As such, these finding may not apply to patients and hospitals which differ significantly from those participating in ACTION. The detection of prior MI was abstracted from medical records depending upon the accuracy of documentation from each hospital and could not be independently verified. The study only examined in-hospital outcomes, so long-term outcomes need to be further evaluated. Prior MI is more likely in NSTEMI vs. STEMI patients, and the burden of co-morbidities is higher with prior MI for both STEMI and NSTEMI, with a high frequency of cardiac risk factors and prior revascularization Prior MI is independently associated with higher in- hospital mortality rates only in NSTEMI patients. Prior MI appears to be a well-documented, independent risk factor for mortality in NSTEMI patients and should be considered as an enrichment criterion for high risk patient enrollment in future ACS clinical trials STEMINSTEMI n=116331n=191315 No Prior MIPrior MINo Prior MIPrior MI n=94238n=22093n=135609n=55706 Age (median, IQR), y 60 (51, 70)62 (53, 72)65 (55, 77)69 (59, 79) Female sex % 30264035 Smoking % 43463130 Hypertension % 59827389 Dyslipidemia % 47785781 Diabetes mellitus % 2132 46 Prior PCI % 8711359 Prior CABG % 4201138 Prior CHF % 3131131 Numbers represent percentages unless noted other wise. Demographics