Key result
Although recurrent acute coronary syndrome was associated with a higher crude 1-year mortality rate than incident cases (14% vs 8%), this difference was no longer significant after multivariable adjustment (HR 0.87).
Why the study?
Recurrence is common after an acute coronary syndrome, and comparing incident versus recurrent cases was needed to better assess prognosis.
Do clinical profiles, treatments, and case fatality rates differ between patients with incident versus recurrent acute coronary syndromes?
Observational (n=1,459)
Yes
Do clinical profiles, treatments, and case fatality rates differ between patients with incident versus recurrent acute coronary syndromes?
Patients with recurrent ACS have more comorbidities and a higher crude 1-year mortality rate than those with incident ACS, though the mortality difference is driven by baseline characteristics such as age and LVEF.
Recurrent ACS does not independently raise 1-year mortality; confirms comorbidities predominate and leaves open recurrence-specific intervention trials.
BACKGROUND: Recurrence is common after an acute coronary syndrome (ACS). In order to better assess the prognosis for patients with ACS, we compared clinical profiles, treatments, and case fatality rates for incident vs. recurrent ACS. METHODS: We enrolled 1,459 men and women (age: 35-74) living in three geographical areas covered by French MONICA registries and who had been admitted to hospital for an ACS in 2015/2016. We recorded and compared the clinical characteristics and medical care for patients with an incident vs. a recurrent ACS. RESULTS: Overall, 431 (30%) had a recurrent ACS. Relative to patients with an incident ACS, patients with recurrence were older (p<0.0001), had a greater frequency of NSTEMI or UA (p<0.0001), were less likely to show typical symptoms (p = 0.045), were more likely to have an altered LVEF (p<0.0001) and co-morbidities. Angioplasty was less frequently performed among patients with recurrent than incident NSTEMI (p<0.05). There were no intergroup differences in the prescription of the recommended secondary prevention measures upon hospital discharge, except for functional rehabilitation more frequently prescribed among incident patients (p<0.0001). Although the crude 1-year mortality rate was higher for recurrent cases (14%) than for incident cases (8%) (p<0.05), this difference was no longer significant after adjustment for age, sex, region, diagnosis category and LVEF. CONCLUSION: Compared with incident patients, recurrent cases were more likely to have co-morbidities and to have suboptimal treatments prior to hospital stay, reinforcing the need for secondary prevention.
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Machta et al. (2022) conducted an observational in Acute coronary syndrome (n=1,459). Recurrent acute coronary syndrome vs. Incident acute coronary syndrome was evaluated on 1-year mortality (HR 0.87, 95% CI 0.59-1.28, p=not significant). Although recurrent acute coronary syndrome was associated with a higher crude 1-year mortality rate than incident cases (14% vs 8%), this difference was no longer significant after multivariable adjustment (HR 0.87).
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