What is the clinical evidence from this study?

Study design: Cohort. Population: Acute coronary syndrome (ACS) (n=1379). Intervention: Standard of care (Observational). Primary outcome: Major adverse cardiovascular events (MACE) defined as the composite of CV death, type 1 AMI, and ischemic stroke (95% CI 26.2-31.0).

What does this research mean for the field?

In an unselected cohort of acute coronary syndrome patients, the cumulative incidence of major adverse cardiovascular events is 10.3% at 1 year and 28.6% over a median follow-up of 4.7 years. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

March 1, 2023Open Access

Incidence and predictors of cardiovascular outcomes after acute coronary syndrome in a population-based cohort study

Key Result

In an unselected cohort of ACS patients, the cumulative incidence of major adverse cardiovascular events was 10.3% at 1 year and 28.6% over a median follow-up of 4.7 years.

Study Design

Type

Cohort (n=1,379)

Multicenter

Structured PICO

Population

1,379 patients hospitalized for acute coronary syndrome (ACS) including NSTEMI (63.6%), STEMI (28.4%), and unstable angina (8.0%), median age 71, 63.9% male, from a single center in Sweden.

Outcome

Major adverse cardiovascular events (MACE) defined as the composite of cardiovascular death, type 1 acute myocardial infarction, and ischemic stroke, at median 4.7 years follow-up.composite

In a contemporary, unselected ACS cohort, the long-term risk of recurrent cardiovascular events remains high (28.6% at 4.7 years), underscoring the need for optimized secondary prevention.

Limitations

Relatively small, single-center cohort
Echocardiography was performed in only 60.1% of patients during hospitalization, limiting multivariable analysis
Only type 1 MIs were included, which might lead to lower event rates compared with register-based studies
Establishment of a primary PCI network during the follow-up period resulted in a switch in reperfusion treatment that might have affected outcomes

Abstract

There is limited data on long-term outcomes after hospitalization for ACS. We aimed to estimate the rate of recurrent cardiovascular events in the long-term, in a population-based, unselected cohort of ACS patients. We included 1379 patients with ACS hospitalized at Östersund hospital 2010-2014 and followed them from the day after discharge to 31 December 2017. The primary endpoint was the unadjusted rate of the composite of CV death, AMI and ischemic stroke. Risk factors for the primary endpoint were assessed in a multivariable Cox proportional hazards regression model. During a median follow-up of 4.7 years, the unadjusted rate of the primary endpoint was 10.3% at 1 year and 28.6% at the end of follow-up. Predictors of increased risk for subsequent events were congestive heart failure, diabetes mellitus, angina pectoris, prior revascularization with PCI or CABG and treatment with diuretics at discharge. Lipid-lowering therapy at discharge and revascularization with PCI or CABG were associated with a lower risk of recurrent events. The risk of recurrent cardiovascular was high at 1 year and continued to be so during the following almost 3 years of median follow-up. Established predictors of cardiovascular risk were confirmed.

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Cite This Study

Ulvenstam et al. (Wed,) conducted a cohort in Acute coronary syndrome (ACS) (n=1,379). Standard of care (Observational) was evaluated on Major adverse cardiovascular events (MACE) defined as the composite of CV death, type 1 AMI, and ischemic stroke (95% CI 26.2-31.0). In an unselected cohort of ACS patients, the cumulative incidence of major adverse cardiovascular events was 10.3% at 1 year and 28.6% over a median follow-up of 4.7 years.

synapsesocial.com/papers/6a10fb4a326831f8a2649e3a https://doi.org/https://doi.org/10.1038/s41598-023-30597-w