Long-term outcomes of the Coordinated Care Program in Patients after Myocardial Infarction (KOS-MI)

Background: The Coordinated Care in Myocardial Infarction Program (KOS-MI) was introduced to improve prognosis for patients after myocardial infarction (MI). The program includes complete revascularization followed by unrestricted access to rehabilitation, electrotherapy, and cardiac care.Aim: This study aimed to assess major adverse cardiac and cerebrovascular events (MACCE) of patients enrolled in the KOS-MI at 3-year follow-up.Methods: This is a retrospective, multicenter registry of patients treated for MI. The study group (KOS-MI) of 963 patients was compared to the control group (standard care) of 1009 patients. At 3-year follow-up, MACCE including death, MI, stroke, and repeated revascularization were reported. Additionally, hospitalization for heart failure (HF) was analyzed. Propensity score matching (PSM) was utilized for group baseline characteristic adjustment.Results: Patients in the KOS-MI group were younger (65 vs. 68 years; P <0.001), mostly men (70% vs. 62.9%; P <0.001), admitted with ST-segment elevation myocardial infarction (STEMI) (44.6% vs. 36.2%; P <0.001). Patients in the control group had more comorbidities and were admitted more often with non-ST-segment elevation myocardial infarction (63.8% vs. 55.4%; P <0.001) and acute HF (5.1% vs. 2.7%; P = 0.007). Following PSM, 530 well matched pairs were selected. At three years (92.3% follow-up completeness), the relative risk reduction was: 25% in MACCE (P = 0.008), 38% in mortality (P = 0.008), 29% in repeated revascularization (P = 0.04), and 28% (P = 0.0496) in hospitalization for HF in the KOS-MI group.Conclusions: The combination of contemporary invasive techniques, complete revascularization, cardiac rehabilitation, and ambulatory care included in the KOS-MI Program improves long-term prognosis of patients after MI in 3-year follow-up.