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Best Practices in Preventing Recurrent Myocardial Infarctions

Patience Nehikhare

Houston Baptist University

NURS 5301: Advanced Nursing Research

Dr. Melanie Eld

June 24, 2020



Best Practices in Preventing Recurrent Myocardial Infarctions


It is well established amongst most medical professionals that myocardial infarction, or

heart attack, is a dangerous medical emergency. In layman terms, a myocardial infarction occurs

when blood flow is blocked in one of the vessels that supply the heart. There is a range of

effective treatment options once the patient is stabilized. Long-term prevention of myocardial

infarction is the goal and is usually achieved with appropriate lifestyle changes and other

behavior modifications. However, once a person has suffered from a myocardial infarction, an

additional heart attack's risk significantly increases. Most research has focused on primary

prevention of this challenging disorder, but less research has been conducted regarding methods

and best practices to prevent a recurrent myocardial infarction. This paper will report a literature

review of appropriate interventions that can reduce the risk of experiencing a second myocardial


Literature review

Brovyk, Rindina, Kravchun, Tabachenko, Yermak, Romanyuk (2019) Factors associated

with recurrent cardiovascular problems in obese patients previously had a heart attack

To analyze the incidence of frequent cardiovascular events in obese patients after MI

during a 6-month duration follow-up, depending on the combination of ticagrelor or Plavix with

aspirin as part of dual antiplatelet therapy (Kern, 2012). The research was in conduction in 75

patients with AMI, ST-segment elevation, and concomitant obesity was divided into two

subgroups. The first included 31 patients who received the combination of ASA + ticaglelor. The

second 44 diseased treated with the conjunction of ASA + clopidogrel in a DAPT; GRACE

scale for risk of hospitalization and 6-month mortality.



In the six month duration follow up, 28 patients had recurrent MI together with unstable

angina (UA), 37.56 % of all patients. In 37.56 % of diseased with acute MI with an elevation of

the ST section and adjunctive obesity, there was a recurrent coronary event in the form of

unstable angina or MI in the existence of an excellent GRACE score. Treatment

recommendations for obese patients who have suffered an MI should include Asprin and

ticagrelor to prevent recurrent events. Obese patients should be more thoroughly assessed to

determine their risk factors for MI, and appropriate interventions should immediately begin.

Myftiu, Sulo, Burazeri, Daka, Sharka, Shkoza, Sulo (2017) Risk factors in initial and

recurrent MI

To analyze the possible un-similarities in the in-hospital and medical profile treatment

amongst in-patients with such incidents and an AMI that is recurrent. The test was in conduction

in 324 diseased in 'Mother Teresa health facility in Albania's coronary section from the year

2013 to the year 2014. Logistical fixation analysis was in place to measure un-similarities in the

earlier, together with recurrent AMI (Hemmings & Egan, 2013). Fifty represented 15.4 percent

and had anterior AMI, repeated incidences were aged where (p=0.01), mostly women were

(p=0.01), minimal literacy levels were (p=0.01), together with fewer smokers where (p=0.03),

repeated incidences at most cases experience heart failure where OR is equal to (2.48 or 95%).

CL represents (1.31-4.70), afflicted left part ventricular expulsion fraction is as OR equals to

(1.97 that is 95%), CL is (1.05-3.71) together with double vessel infections is OR equals to (6.32

that is 95%) CL is (1.43-28.03) in comparison with incident scenarios.

Most severe medical expressions in the condition and minimum utilization of treatment in

repeated AMI causes poor prognosis. There is an immediate necessity in focusing on preventive


strategies. Patients with associated risk factors need more in-depth treatment planning to

encourage significant lifestyle changes.

Karjalainen, Nimela, Laine, Airaksinen, Ylitalo, Nammas (2016). Stent under expansion

after stent implementation following an MI

The study performed an analysis of comparing post-coronary dilation in chronic MI

prevention to those that did not have post-coronary dilation. It was a post hoc analysis in basal

ACS attempts, which involved 827 diseased (1:1) who had ACS to get everolimus-eluting tubing

or titanium-nitride-oxide coated bioactive tubing's. Out of the 827 infected who took part in the

basal ACS attempts, 357 that is 43.2%, goes through PD. They would undergo an average follow

up for five years. Diseased individuals who experienced the PD had lower non-fatal MI scenarios

at prolonged follow-ups when, in comparison with the patients who did not go through it (4.5%

versus 8.5%, p represents (0.02).

The MACE rates of 15.7% versus 15.1%, where p represents (0.81), diseased individuals

who received treatment with initial transdermic coronary intercession for ACS who were through

the PD had minimal frequent. Non-fatal MI scenarios for a prolonged follow up when in

comparison with the patients who never underwent through it; rates of MACE were different in a

significant manner. More studies should observe the effects of PD stents to prevent recurrent MI.

Patients with a stent should be assessed to determine whether post-coronary dilation occurred.

Kanuri, Ipe, Kassab, Gao, Liu, Skaar, Kreutz (2018). Modification of the physiologic

functioning in the cardiovascular system due to variations in micro-RNA

The research was performing a study on circulatory miRNAs possible events as the reliable

bio-markers in the stratification of risks and earlier identification of cardiovascular scenarios.

Blood representations were collected from four hundred and thirty-seven patients who had a


cardiac operation, who then had experiences of repeated cardiovascular situations in an average

follow up of one and a half years (Watchie, 2020). A differential form of mi-RNA aspect was

found in controls, CAD diseased with no events, together with CAD diseased with repeated

occurrences. Mi-RNA was earlier in association with stroke, arrhythmia, heart hypertrophy,

cardiac failure, angiogenesis, platelets, vascular delicate muscular cells, endothelial

responsibilities, CAD, and MI happens to be in expression in the case study.

70 mi-RNA, which represents FDR less than 0.05, were in connection with repeated MI

and future tubing thrombosis as in comparison with CAD diseased with sub-sequential non-event

follow-ups (Hutchison, 2019). Mi-RNA following generation running gives a demonstration of

altered finger profiles of blood mi-RNA aspect in people who had following repeated thrombotic

scenarios on a measure of clinical therapy when in comparison with patients who had no repeated

cardiovascular situations. Investigating the specific risk factors in Mi-RNA sequences may be

useful. Knowing a patient is at higher risk due to Mi-RNA variations could assist with treatment


Osmak, Titov, Matveeva, Bashinskaya, Shakhnovich, Sukhinina, Kukava, Ruda, Favorova

(2018). Adverse cardiovascular events and increased mortality following an MI

It was a retrospective study whose aim was to evaluate the allelic fluctuations in 9p, where

it represents 21.3 venue and twenty-one atherogenesis genes concerning the development of

rough heart events in a study of diseased of Russian race after the initial AMI during a prolonged

follow-up. The study involved 133 diseased, who were 104 males together with 29 females. The

average age was 53.9 ± years 9.3, with the initial MI being the indicator scenario of enrollments

in the year 2013 to the study on the grounds of prolonged follow-up. Link analysis concerning


the polymorphous loci and Haplo's perspective of 4.2 packages gave the entire link imbalance of

10757278rs and 133049rs in the 9ptwenty one area D equals one and LOD is less than 2.

Kaplan-Meier arc often depicts of un-favorable results in various times for carriers in

genotypes or alleles of 9ptwenty one (133049rs, 10757278rs) together with MTHFR, which

represents 1801133rs. Some atherogenesis and myocardial Infarction loci can influence

prolonged infringement prognosis of rough heart events in diseased that go through initial MI

generally 9ptwenty one 133049rs*GG, and MTHFR 1801133rs*TT happen to be hazard

genotypes in un-favorable results. Persons with Russian ethnicity could benefit from a genetic

analysis before an MI.

Radovanovic, Maurer, Bertel, Witassek, Urban, Stauffer, Pedrazzini, Erne (2016). Therapy

and outcome differences in patients with initial and recurrent MI

The study aims to evaluate the prior MI impact on outcomes and therapies in the diseased

person who is given an evaluation MI on the ST. All patients having the STEMI found from

2002 to 2014 in the AMIS registry plus were in inclusion (Mehta, 2012). Consequences were

analyzed by the use of regression of the logistic multivariate. From 19, 665 STEMI diseased

persons, 2845, that is 14%, were having re-MI. These infected individuals were aged 69.5 years

and 64.2 years, most frequently were men, having more risk factors, and more comorbidity

(Fuster & Narula, 2012). Diseased individuals are having re-MI presented in 25 minutes earlier

than the one having first MI were most frequent in the class of Killip of ¾. And were less likely

to be receiving a guide with the recommendation of drug therapy, aspirin P2Y12 inhibitors 76%

versus 83%; p is less than 0.001, 93% versus 97%; p is less than 0.001, or statins 73% versus

77%; p is less than 0.001, or undergo significant intervention of transdermic coronary of 77%

versus 87%; p is less than 0.001.



A sub-group name n equals 4486 was compiled after a one-year discharge and was 3893

with the MI at first, together with 593 with re-MI having initialized hospitalization. Rate of crude

was 2.9 percent to the diseased person having the 1st MI as 6.7 percent for the ones with re-MI

and 1.68, 95 percent CI 1.14–2.47; p represents 0.008. The infected persons having the recurrent

M1 were less receiving the evidence care or had wrong health centers in one-year consequences

than a diseased person having first MI. Patients with recurrent MI find help for their way of

discomfort even if they don't have symptoms according to levels of biomarker; they also had a

small recurrent MI. Long term and short term patient’s management with recurring MI must

have an improvement.

Dias, Maier, Junior, Moser, Santos, Oliveira (2019). Possible factors associated with risk

for recurrent MI

The aim was investigating the factors possible for the occurrence of acute myocardial

infarction of the diseased person going in the care of coronary in the relatives’ perspective.

Qualitative, descriptive, and case studies were in use in collecting data using pilot interviews.

The relative had a report that the physically intense activity done by the diseased person, taking

off more alcohol and other drugs therapy, have also contributed to another event of the AMI

(Basson & Lerman, 2019). The similar said that the received guidance, they were for the

prescribed medicines; highlight the lack of advice concerning the changes in the realization of

the similar professional of health care and lifestyle, particularly the nursing staff. The guidelines

in accordance to the increase have not to effect in prevention the AMI recurrence and highlight

the requirements of re-thinking on the role of the professional nursing having the relationship to

the provided guidelines, as a kind of facilitation to the diseased person to the changes of life and

medication treatment.


Implementing of the permanent and a particular program of education for these caring

lines are required in the highlighting of the nursing actions of producing measures of

rehabilitation and cardiovascular prevention, ensure that the social, mental and physical

condition and focus on the disease (Crawford, DiMarco & Paulus, 2019). Healthcare facilities

need specific treatment plans established for patients with a previous MI. Risks for recurrent MI

in the year following the initial. Do re-hospitalizations after AMI further increase the risk of

recurrent AMI? The Clinical Classifications Software was used to classify re-hospitalizations

into disease categories. A Cox regression model was fit accounting for CCS-specific

hospitalizations as time-varying variables and patient characteristics at discharge for the index

AMI, adjusting for the competing risk of death. The rate of 1-year recurrent AMI was 5.3%. 95%

CI, 5.27%–5.41%, and median or inter-quartile range time from discharge to recurrent AMI was

115 in 34 to 230 days.

Eleven disease categories; diabetes mellitus, anemia, hypertension, coronary

atherosclerosis, heart disease, pneumonia, chest pain, gastrointestinal and chronic obstructive

pulmonary disease, bleeding, and renal failure, complications of implant or graft were associated

with increased risk of recurrent AMI. Septicemia was associated with lower recurrence risk.

Hazard ratios ranged from 1.6, 95 percent CI, 1.55 to 1.70, heart disease to 1.1, 95 percent CI,

1.04 to 1.25, pneumonia to 0.6, 95% CI, 0.58–0.71, septicemia. Patient risk of recurrent AMI

changed based on the occurrence of hospitalizations after the index AMI. Risk-stratification after

an acute myocardial infarction is necessary to inform the choice of clinical strategies. Improving

post-acute care to prevent unplanned re-hospitalizations, especially re-hospitalizations for

chronic diseases, and extending the focus of outcomes measures to condition-specific re-

hospitalizations within 30 days and beyond is vital for the secondary prevention of AMI.



A sharp MI is in management by the team of international professionals with a dedication

to heart failure. However, the cardiologist, the team, has a cardiac surgeon, a cardiologist's

intervention, rehabilitation of cardiac, vital cardiology, and care nurses, together with physical

therapists. Since most of the patients die before going to health centers, the key is educating the

diseased person of the early arrival and symptoms to the emergency department. The primary

care, nurse practitioner, and pharmacist must inform the patient on taking nitro-glycerine, and if

not relieved after three doses, call 911. The nurses must communicate immediately with the team

of the inter-professional as the reperfusion time is limited. The cardiologist must be in

consideration of the vessel clot independence to the indication and symptoms duration. All

diseased individuals need monitoring of the ICU.

Nurses must be vigilant on the concern towards the potentiality of life threaten,

communicate, and complications with the team if they are not healthy. None of the patients

should be discharged prematurely since MI complications may occur even for a week after MI.

After the stabilization, diseased individuals need to be educated by the nurses concerning the risk

reduction factor for coronary artery disease. After a patient is discharged, the sick person must

come into a cardiac rehabilitating unit, consume a healthier diet, end smoking, reduce alcohol,

reduction in body weight, together with lowering the bodily fluid level of dextrose and

cholesterol. Diseased person must get education comprising of medication benefits and to lower

blood cholesterol. It is crucial to check for the interaction and educate the patient concerning the

compliance important



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Demos Medical Publishing.

Crawford, M. H., DiMarco, J. P., & Paulus, W. J. (2019). Cardiology E-book. Elsevier Health


Fuster, V., & Narula, J. (2012). Coronary risk factors update an issue of medical clinics - E-

book. Elsevier Health Sciences.

Hemmings, H. C., & Egan, T. D. (2013). Pharmacology and physiology for anesthesia:

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Hutchison, S. J. (2019). Complications of myocardial infarction: Clinical diagnostic imaging

atlas. Elsevier Health Sciences.

Kern, M. J. (2012). The interventional cardiac catheterization handbook E-book. Elsevier

Health Sciences.

Mehta, S. (2012). STEMI interventions, an issue of interventional cardiology clinics - E-book.

Elsevier Health Sciences.

Watchie, J. (2020). Cardiovascular and pulmonary physical therapy - E-book: A clinical

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