Established coronary artery disease predicts poor outcomes in ACS
Acute coronary syndrome (ACS) patients with a background of myocardial infarction of previous revascularization tend to suffer from poorer outcomes, a new study suggests.
The study included 12,878 ACS patients who underwent percutaneous coronary intervention (PCI). Those with a history of myocardial infarction, PCI or coronary artery bypass graft surgery (CABG) were defined as having established coronary artery disease (CAD). Study endpoints included mortality and major adverse cardiovascular events (MACE) at 12 months.
Of the participants, 3,542 had established CAD (mean age, 67.5±12.0 years; 77 percent male) while 9,336 had de novo CAD (mean age, 63.1±12.5 years; 74 percent male). Those with established CAD tended to be older, have more comorbidities and present with high-risk features.
In the established CAD cohort, there were 281 deaths within 12 months. This was significantly higher than that in patients with de novo CAD (n=507; 8 percent vs 5 percent; p<0.001). A similar finding was reported for 12-month MACE, which occurred with a significantly higher frequency in those with established CAD (20 percent vs 13 percent; p<0.001).
Trends were the same for secondary endpoints. Twelve-month myocardial infarction, for instance, was significantly more common in those with established CAD (8 percent vs 3 percent; p<0.001), as were 12-month stroke (2 percent vs 1 percent; p=0.001), target vessel revascularization (9 percent vs 6 percent; p<0.001) and rehospitalization for ACS (17 percent vs 11 percent; p<0.001).
Multivariate logistic regression analysis, however, showed that established CAD was significantly predictive only of 12-month MACE (odds ratio [OR], 1.40; 95 percent CI, 1.23–1.58; p<0.001) and not 12-month mortality (OR, 1.08; 0.77–1.52; p=0.66).