Mid-term clinical outcome of patients treated for acute coronary syndrome-data from the registry

Abstract

Aim of the study: what are the prognosticators of mid-term outcome in patients treated because of acute coronary syndrome. Methods: Longitudinal retrospective-prospective single center study that analyze, type of ACS (STEMI/NSTEMI/APNS), hemodynamic parameters (heart rate and SBP on the admition), type of treatment (PCI vs medical), LV ejection fraction, extent and severity of CAD, medication used, medications post discharge, type and time to event. Statistical analyze: descriptive and comparative analyze, uni and multivariate regression analyze, Caplan-Meier event free survival analyze. Results: 364 patients treated for ACS, at mean age 63,1±11,1 y., 246(67,4%) males and 119(32,6%) females, were followed up for mean 18.6±10,4 months. A total of 95 cardiac events (CE) in 94(25,8%) patients during the 364pts./563.7 y. follow up were registered, or 17.6% annually. 8 (2.2%) cardiac deaths (CD) were registered, or 1.5% annually death rate. Ischemic events were the most frequent (59-15,7%): angina-14(3,9%), scheduled revascularization after ACS because of multivassel CAD-31(8.5%), and acute ischemic event leading to re-revascularization-12(3.3%) pts. Symptomatic heart failure-20(5.5%) pts. leading to CD in 5, 7(1,4%), ischemic CVI with one fatal event, atrial arrhythmias in 8(2,2%) and malignant ventricular arrhythmias in 4(1,1%) pts. one with fatal ending, and one sudden CD. 58(61,7%) out of 94 events occurred during the first 6 months after the ACS. Univariate predictors were: medications used: DAPT: beta -2.147, p=0.000, expB 0.117; beta blockers: beta -.952, p=0,004, exp(B) 0,386; BB+RAAS inhibitors: beta -.765, p=0,015, exp(B) 0,465; diuretics: beta 1,189, p=0,007; exp(B) 3.284; ASA prior the first event: beta -1.055, p=0,000; exp(B) 0.345; diabetes: beta .788, p=0.006, exp(B) 2.199; anemia: beta1,090, p=0,006, exp(B) 2.975; age: beta.155, t 2.198, p=0.029; HR beta.155, t 3.274, p=0.001; number of lesions: beta.105, t 2.009, p=0.045; In a backword conditional logistic regression model six independent predictors were identified: ASA prior the first event exp(B) .537, p=0.049; DAPT exp(B) 2.245, p=0.000; BB+RAAS exp(B) .492, p=0.046; diuretics exp(B) 3.087, p=0.18; DM exp(B), p=0.014; Conclusion: The prevalence of CE during the mid-term follow up in ACS patients was 17.6%, with 1.5% death rate annually. Diabetes is a powerful independent predictor of mid-term outcome in patients treated for ACS. But taking aspirin therapy prior to the event, DAPT, combined BB+RAAS inhibitor after the treatment for ACS are significant positive prognosticators, as opposite taking diuretic therapy is a negative prognosticator of mid-term outcome in these patients.