Factors influencing the survival rate of patients after acute coronary syndrome and percutaneous coronary intervention, 5-year follow-up

Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science Introduction Reduction in mortality from acute coronary syndrome (ACS) is an important medical and social problem. Determination of survival predictors can improve the effectiveness of secondary prevention and medical care provision in patients with ACS. Aim To determine the factors influencing 5-year survival in patients after ACS and percutaneous coronary intervention (PCI). Methods The study presents data obtained as a result of a registry study The analysis included 135 with ACS and PCI. Patients were contacted and examined in a year, and then 5 years after. The laboratory parameters (lipids, markers of inflammation and endothelial dysfunction) were determined upon admission to the hospital and after 60 months. The probability of 5-year survival for patients undergoing ACS and PCI was assessed by Kaplan-Mayer method. Log-rank test was used to compare the survival rate for the entire follow-up period in two groups. The Cox regression model was used to assess the impact of independent factors on survival and to predict risk of event. Results During the follow-up period, 18 people died (the average age of the deceased was 60.9 ± 13.5 years; of the living, 60.0 ± 8.9 years). Survival after 1 year was 97.1%, after 5 years-86.7%. According to the results of the Cox regression analysis, the risk of death increased in the presence of chronic kidney disease (CKD) (HR 15.1; 95 % CI 4.30-52.93; p = 0.001); diabetes mellitus (DM) (HR 3.67; 95% CI 1.18-11.43; p = 0.025) and a history of stroke (HR 9.07; 95% CI 1.85-44.60; p = 0.007). The prognosis was negatively affected by high pulse blood pressure (PBP) ≥ 60 mm Hg (HR 4.68; 95% CI 1.60-13.72; p = 0.005), heart rate >80 beats per minute (OR 4.34; 95% CI 1.51-12.26; p = 0.006). Significant risk factors for death from all causes were the number of platelets (OR 1.011 95% CI 1.003-1.019; p = 0.010), the level of homocysteine (OR 1.172 95% CI 1.008 - 1.364; p = 0.040), and an increase in matrix metalloproteinase-9 (MMP-9) >249 ng/ml (OR 7.052; 95% CI 1.346 - 36.950; p = 0.021). Conclusions According to a register study, the survival rate of patients after ACS and PCI after 5 years depended on the presence of comorbid pathology (CKD, DM, and a history of stroke). Factors that had a negative impact on the prognosis were high indicators of PBP and heart rate, as well as laboratory markers of cellular (platelets) and vascular inflammation (homocysteine, MMP9).