Key result
Three-vessel and LMCA disease linked to worse post-ACS survival with ~20% mortality.
Why the study?
The contribution of the degree and nature of coronary bed lesions to long-term prognosis after ACS and endovascular treatment remained underinvestigated in the Russian population.
Does the degree of coronary bed lesion on invasive coronary angiography predict long-term overall and cardiovascular survival in patients with a history of acute coronary syndrome?
Cohort (n=1,506)
No
Does the degree of coronary bed lesion on invasive coronary angiography predict long-term overall and cardiovascular survival in patients with a history of acute coronary syndrome?
In a Russian cohort of patients post-acute coronary syndrome, 3-vessel coronary disease and left main coronary artery lesions are key predictors of reduced long-term overall and cardiovascular survival, whereas 1- and 2-vessel disease have survival rates similar to patients without significant stenosis.
Answers are grounded in this paper and cite their sources.
May aid post-ACS risk stratification by lesion extent; extends observational data but leaves open therapeutic implications.
Background: management of patients with acute coronary syndrome (ACS) is based on invasive coronary angiography (CAG) and subsequent endovascular treatment. The contribution of degree and nature of coronary bed lesion to the longterm prognosis in such patients is still underinvestigated in the Russian population. Aim: to evaluate survival rate in patients with a history of ACS depending on angiographic examination results and features of subsequent endovascular treatment. Materials and Methods: a prospective cohort followup study included 1506 patients with diagnosed acute myocardial infarction (I21 according to ICD10), recurrent myocardial infarction (I22 according to ICD10) or unstable angina (I20 according to ICD10) who were treated at the Tula Regional Vascular Center in 2019–2020. According to CAG results, the patients were divided into 5 groups: those without hemodynamically significant coronary artery stenosis, those with hemodynamically significant stenosis of 1, 2 or 3 vessels, and those with left main coronary artery (LCA) lesion. Also, endovascular treatment features such as infarctrelated artery stenting incidence, stent types (with or without drug coating), and revascularization completeness were also evaluated. Average follow–up period was 42.1 (29.5–48.1) months. Results: 297 (19.7%) patients died after discharge from the hospital, and 152 (10.1%) subjects died from cardiovascular causes. According to the survival analysis performed by the Kaplan—Meier method, no significant differences were found between the groups without hemodynamically significant stenosis, with 1 and 2vessel stenosis, whereas the groups with 3vessel stenosis and LMCA lesion formed a separate highrisk category that was significantly different from the first three groups in terms of overall and cardiovascular survival rate in all pairwise comparisons (p<0.05). Conclusion: the degree of coronary bed lesion is a significant predictor of survival rate after ACS. An unfavorable prognosis is associated specifically with a threevessel lesion and LMCA lesion. Along with this, no significant differences were detected in survival rate between the groups without hemodynamically significant stenosis, with 1 and 2vessel stenosis. KEYWORDS: acute coronary syndrome, myocardial infarction, cardiovascular diseases, cardiovascular mortality, coronary angiography, percutaneous coronary intervention. FOR CITATION: Efremova Yu.E., Potekhina A.V., Dolgusheva Yu.A., Osokina A.K., Filatova A.Yu., Gornyakova N.B., Lazareva N.V., Atyunina I.V., Konosova I.D., Shestova I.I., Sorokin E.V., Provatorov S.I. Degree of coronary bed lesion and survival rate in patients with a history of acute coronary syndrome. Russian Medical Inquiry. 2026;10(9):590–599 (in Russ.). DOI: 10.32364/2587-6821-2026-10-9-1
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Efremova et al. (2026) conducted a cohort in Acute coronary syndrome (acute myocardial infarction, recurrent myocardial infarction, or unstable angina) (n=1,506). Three-vessel coronary stenosis or left main coronary artery (LMCA) lesion vs. No hemodynamically significant coronary artery stenosis, 1-vessel stenosis, or 2-vessel stenosis was evaluated on Overall and cardiovascular survival rate after hospital discharge (p=<0.05). Three-vessel coronary stenosis and LMCA lesions were associated with worse overall and cardiovascular survival after ACS vs 0-, 1-, or 2-vessel disease.
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