Multimorbidity in Acute Coronary Syndrome

Figure 1. Summary Flowchart Depicting the Literature Search The full PRISMA diagram is included in the Supplemental Appendix (Supplemental Figure 1). ACS = acute coronary syndrome; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Central Illustration. The Prevalence and Impact of Multimorbidity Inacute Coronary Syndrome BMI = body mass index; CABG = coronary artery bypass graft; MACE = major adverse cardiovascular events; MI = myocardial infarction; n = number; PCI = percutaneous coronary intervention; RR = relative risk; other abbreviations as in Figure 1, Figure 2.

Figure 2. Prevalence of ≥2 Pre-Existing Long-Term Conditions at ACS by Study A random effects model was used, implementing the Freeman-Tukey (double arcsine square root) transformation. CIs were calculated using the score statistic method and are shown in black if outside the effect size marker, and white within the marker. Note: CIs are very small for many individual studies owing to their large sample sizes. These may not be visible behind the study marker. nmultimorbidity = number of patients with ≥2 long-term conditions at ACS diagnosis in study; HIC = high-income country; LMIC = low- to middle-income country; ntotal = total number of patients with MI in study, other abbreviation as in Figure 1.

Figure 3. Association Between Long-Term Conditions Studied and Reported Prevalence of Multimorbidity Trend line calculated using DerSimonian and Laird (inverse variance) weighting method. Summary of meta-regression: β = 0.009 (95% CI: 0.007-0.012); P < 0.001; R2 = 79.6%. Abbreviation as in Figure 1.

Figure 4. Association Between Pre-Existing Multimorbidity, Short and Longer Term All-Cause Mortality θ = effect size; D&L = DerSimonian and Laird; MLE = maximum likelihood estimation; NSTE-ACS = non–ST-segment elevation acute coronary syndrome; REML = restricted maximum likelihood; STEMI = ST-segment elevation myocardial infarction.

Figure 5. The Association Between Multimorbidity Burden and All-Cause Mortality The increased risk per additional long-term condition is shown. Abbreviations as in Figure 4.