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Managed Care after Acute Myocardial Infarction (MC-AMI) - Poland's nationwide program of comprehensive post-MI care - improves prognosis in 2-year follow-up. A single high-volume center intention to treat analysis.

BACKGROUND
The Managed Care in Acute Myocardial Infarction (MC-AMI) is a program introduced in Poland aimed at comprehensive, scheduled, and supervised care for AMI patients to improve long-term prognosis.


AIMS
To compare 24-month mortality and the incidence of major adverse cardiovascular events (MACE: a composite of death, recurrent MI, and hospitalization for heart failure) in a cohort of AMI patients treated in MC-AMI era (intention to treat analysis) vs. similar population treated before MC-AMI era.


METHODS
We analyzed 2323 consecutive patients with AMI: 1261 patients enrolled in MCAMI era (study group) and 1062 patients treated 12 months before MC-AMI era (control). In the study group, 57% participated in MC-AMI, while 43% of patients remained under standard care. The patients were followed-up for 24 months. Mortality and MACE were recorded.


RESULTS
Treatment in MC-AMI era was related to a 30% reduction of all-cause mortality, and 14% reduction of MACE, although it was not related to the reduction of hospitalization due to heart failure (HF) or AMI in 24-months. The 24-month survival was the highest in MC-AMI enrolled patients, while patients treated in the MC-AMI era, but not enrolled had a similar prognosis to those treated before MC-AMI era. Multivariable Cox regression analysis revealed the MC-AMI era to be inversely associated with mortality in 24-month-follow-up (hazard ratio [HR], 0.49; 95% confidence interval [Cl], 0.38-0.65; P <0.001).


CONCLUSIONS
AMI treatment in MC-AMI era reduces 24-month mortality and MACE. Moreover, AMI treatment in MC-AMI is inversely related to mortality, MACE, and hospitalization for HF. The effect is pronounced in patients enrolled in MC-AMI.