Clinical outcomes associated with recurrent compared to first-time myocardial infarction

Christensen, DM; Garred, CH; Malmborg, M; Sindet-Pedersen, C; Zahir, D; Nouhravesh, N; Fosbøl, E; Docherty, KF; Butt, JH; McMurray, JJV; Petrie, MC; Pfeffer, MA; Køber, L; Schou, M

doi:10.1016/j.ahj.2026.107592

Clinical outcomes associated with recurrent compared to first-time myocardial infarction

Am Heart JPublished 30 Aug 2026nationwide registries

Main finding · Composite of all-cause mortality, hospitalization for heart failure (HHF), and further recurrent MIResultSummary relative risk 1.39 95% CI 1.34–1.44

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Authors' conclusion

Recurrent MI is associated with a higher risk of all-cause mortality, HHF, and further recurrent MI compared with first-time MI.

Study context

Population: Patients with recurrent myocardial infarction (MI) and age- and sex-matched patients with first-time MI in Denmark between 2015 and 20228,397 patients with recurrent MI and 8,397 with first-time MI (median age 73, 70.7% male)
Participants: 8,397 vs 8,397

Exposure: Recurrent MI vs first-time MI
Recurrent MIn = 8,397
First-time MIn = 8,397
Outcome: Composite of:
All-cause mortality
Hospitalization for heart failure (HHF)
Further recurrent MI
Follow-up: 1-year

Methodological detailsmatched 1:1 on age and sex, consecutive patients, Denmark between 2015 and 2022

Matched 1:1 on age and sex
Consecutive patients
Denmark between 2015 and 2022

Main finding

As reported in the abstract

Summary relative risk

1.39

95% CI 1.34–1.44

By group

Recurrent MI24.0%standardized 1-year risk

First-time MI17.2%standardized 1-year risk

Recurrent MIvs first-time MI

sRR 1.39 (95% CI 1.34–1.44)

Observational data: associations, not effects.

Further findings

Outcome	Recurrent MI	First-time MI	← Lower risk with recurrent MI ←→ Higher risk with recurrent MI →	sRR (CI)
All-cause mortality	14.6%	11.3%	0.20.5125	1.29 (1.24–1.35)
HHF	6.6%	6.0%	0.20.5125	1.11 (1.00–1.21)
Recurrent MI	6.7%	2.2%	0.20.5125	3.01 (2.71–3.45)
			0.20.5125Summary relative risk (log scale)

Use of guideline-recommended treatments postdicharge

Percutaneous coronary intervention

Recurrent MI53.7%

First-time MI64.3%

Lipid-lowering treatment

Recurrent MI78.1%

First-time MI83.2%

P2Y12 inhibitor

Recurrent MI77.3%

First-time MI82.6%

Use of guideline-recommended treatments postdicharge: percutaneous coronary intervention P < .001
Use of guideline-recommended treatments postdicharge: lipid-lowering treatment P < .001
Use of guideline-recommended treatments postdicharge: P2Y12 inhibitor P < .001

Comorbidities

Patients with recurrent MI had more comorbidities

Original publication

Clinical outcomes associated with recurrent compared to first-time myocardial infarction. Am Heart J. Published 30 August 2026. doi:10.1016/j.ahj.2026.107592

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