OBJECTIVES: To describe the characteristics and treatment of patients having a myocardial infarction (MI) and estimate the incidence of cardiovascular events following the index MI, in the French Health Insurance database. METHODS: A cohort of patients who had an MI in France between 2007 and 2011 was extracted from a claims database: the Echantillon Généraliste de Bénéficiaires (a 1% representative sample of subjects covered by the general health insurance (≈600,000 patients). The incidence of cardiovascular events following the index MI was estimated using the Kaplan Meier method. A cox survival model aims to identify factors related to the composite outcome (death/MI/stroke). RESULTS:

For deaths (all cause and including in-hospital death): 17.8% (CI95%=16.0%;19.5%), 21.6% (CI95%=20.7%;23.5%), 27.0% (CI95%=25.8%;29.1%);

For MI (recurrence): 3.1% (CI95%=2.3%;3.8%), 4.1% (CI95%=3.2%;5.0%%), 4.7% (CI95%=3.7%;5.7%);

For stroke (or transit  ischemic attack): 1.9% (CI95%=1.3%;2.5%), 3.1% (CI95%=2.3%;3.9%%), 4.1% (CI95%=3.1%;5.0%);

For the composite outcome (death/MI/stroke) : 20.7% (CI95%=18.9%;22.5%), 26.0% (CI95%=24.0%;28.0%), 32.1% (CI95%=29.8%;34.3%).

A cox multivariate survival model identified the following independent correlates of the composite outcome: age (ref <60y)  (60-70y: HR=2.071 CI=[1.051;2.820], 70-80y: HR=3.463 CI=[2.640;4.541], >80y: HR=7.124 CI=[5.946;9.235]), diabetes (HR=1.229,CI=[1.028;1.469])  percutaneous coronary intervention  (HR=0.579,CI=[0.457;0.689]), and coronary artery bypass grafting  (HR=0.558,CI=[0.359;0.869] CONCLUSIONS: Despite high rates of prescription of medical therapy, all-cause mortality and CV event rates remained high following MI. This underscores the need to improve secondary prevention.