Complete revascularization- the sub-analysis from the 3-year coordinated myocardial infarction care program (KOS-MI) registry

Abstract Background Poland’s Managed Care in Acute Myocardial Infarction Program (KOS-MI) has improved post-MI care and reduced mortality. One of crucial aim of the program was complete revascularization (CR) of coronary arteries. Aims This study comprehensively assessed the influence of CR on long-term outcomes of participants of the KOS-MI program. Methods This retrospective, multicenter registry included 1972 MI patients, of whom 48.9% (n=960) participated in the KOS-MI program. Patients were divided into four groups: KOS-MI participants with (KOS-C; n=543) and without (KOS-nC; n=417) CR, and non-participants with (nKOS-C; n=421) or without (nKOS-nC; n=581) CR. At 3-year follow-up, MACCE (death, MI, stroke, and repeated revascularization) and heart failure hospitalizations were assessed. Cox-regression analysis was also performed, including sex-specific subgroups. Results KOS-C group had significantly lower rates of death (6.2%), MI (3.6%), and repeated revascularization (5.6%), MACCE occurred in 12.8%. Comparable outcomes were observed in the KOS-nC and nKOS-C groups. Cox analysis revealed the highest risk of mortality (HR=1.99; 95%CI: 1.27–3.12) and MACCE (HR=2.67; 95%CI: 1.94–3.68) in patients outside the KOS-MI program without CR (nKOS-nC). Key predictors of adverse events were diabetes (HR=1.85) and three-vessel disease (HR=1.89) in men, and chronic kidney disease (HR=1.83) in women. Left ventricular ejection fraction and age showed linear associations with mortality (p<0.0001) and MACCE (p<0.001), with no nonlinear effects. Conclusions Over 3 years, KOS-MI patients with CR showed the most favorable outcomes across key endpoints. Those with incomplete revascularization in the program had results similar to the nKOS-C group, highlighting the importance of CR and KOS-MI participation.