Long-term risk of death and recurrent cardiovascular events following acute coronary syndromes.

Estimates of the risk of recurrent cardiovascular events (residual risk) among patients with acute coronary syndromes have largely been based on clinical trial populations. Our objective was to estimate the residual risk associated with common comorbidities in a large, unselected, population-based c...

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Autores principales:	Pishoy Gouda, Anamaria Savu, Kevin R Bainey, Padma Kaul, Robert C Welsh
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/28b714938c7847b1b367db703dba3e12
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spelling	oai:doaj.org-article:28b714938c7847b1b367db703dba3e122021-12-02T20:09:44ZLong-term risk of death and recurrent cardiovascular events following acute coronary syndromes.1932-620310.1371/journal.pone.0254008https://doaj.org/article/28b714938c7847b1b367db703dba3e122021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0254008https://doaj.org/toc/1932-6203Estimates of the risk of recurrent cardiovascular events (residual risk) among patients with acute coronary syndromes have largely been based on clinical trial populations. Our objective was to estimate the residual risk associated with common comorbidities in a large, unselected, population-based cohort of acute coronary syndrome patients. 31,056 ACS patients (49.5%-non-ST segment elevation myocardial infarction [NSTEMI], 34.0%-ST segment elevation myocardial infarction [STEMI] and 16.5%-unstable angina [UA]) hospitalised in Alberta between April 2010 and March 2016 were included. The primary composite outcome was major adverse cardiovascular events (MACE) including: death, stroke or recurrent myocardial infarction. The secondary outcome was death from any cause. Cox-proportional hazard models were used to identify the impact of ACS type and commonly observed comorbidities (heart failure, hypertension, peripheral vascular disease, renal disease, cerebrovascular disease and diabetes). At 3.0 +/- 3.7 years, rates of MACE were highest in the NSTEMI population followed by STEMI and UA (3.58, 2.41 and 1.68 per 10,000 person years respectively). Mortality was also highest in the NSTEMI population followed by STEMI and UA (2.23, 1.38 and 0.95 per 10,000 person years respectively). Increased burden of comorbidities was associated with an increased risk of MACE, most prominently seen with heart failure (adjusted HR 1.83; 95% CI 1.73-1.93), renal disease (adjusted HR 1.52; 95% CI 1.40-1.65) and diabetes (adjusted HR 1.51; 95% CI 1.44-1.59). The cumulative presence of each of examined comorbidities was associated with an incremental increase in the rate of MACE ranging from 1.7 to 9.98 per 10,000 person years. Rates of secondary prevention medications at discharge were high including: statin (89.5%), angiotensin converting enzyme inhibitor/angiotensin receptor blocker (84.1%) and beta-blockers (85.9%). Residual cardiovascular risk following an acute coronary syndrome remains high despite advances in secondary prevention. A higher burden of comorbidities is associated with increased residual risk that may benefit from aggressive or novel therapies.Pishoy GoudaAnamaria SavuKevin R BaineyPadma KaulRobert C WelshPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 7, p e0254008 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Pishoy Gouda Anamaria Savu Kevin R Bainey Padma Kaul Robert C Welsh Long-term risk of death and recurrent cardiovascular events following acute coronary syndromes.
description	Estimates of the risk of recurrent cardiovascular events (residual risk) among patients with acute coronary syndromes have largely been based on clinical trial populations. Our objective was to estimate the residual risk associated with common comorbidities in a large, unselected, population-based cohort of acute coronary syndrome patients. 31,056 ACS patients (49.5%-non-ST segment elevation myocardial infarction [NSTEMI], 34.0%-ST segment elevation myocardial infarction [STEMI] and 16.5%-unstable angina [UA]) hospitalised in Alberta between April 2010 and March 2016 were included. The primary composite outcome was major adverse cardiovascular events (MACE) including: death, stroke or recurrent myocardial infarction. The secondary outcome was death from any cause. Cox-proportional hazard models were used to identify the impact of ACS type and commonly observed comorbidities (heart failure, hypertension, peripheral vascular disease, renal disease, cerebrovascular disease and diabetes). At 3.0 +/- 3.7 years, rates of MACE were highest in the NSTEMI population followed by STEMI and UA (3.58, 2.41 and 1.68 per 10,000 person years respectively). Mortality was also highest in the NSTEMI population followed by STEMI and UA (2.23, 1.38 and 0.95 per 10,000 person years respectively). Increased burden of comorbidities was associated with an increased risk of MACE, most prominently seen with heart failure (adjusted HR 1.83; 95% CI 1.73-1.93), renal disease (adjusted HR 1.52; 95% CI 1.40-1.65) and diabetes (adjusted HR 1.51; 95% CI 1.44-1.59). The cumulative presence of each of examined comorbidities was associated with an incremental increase in the rate of MACE ranging from 1.7 to 9.98 per 10,000 person years. Rates of secondary prevention medications at discharge were high including: statin (89.5%), angiotensin converting enzyme inhibitor/angiotensin receptor blocker (84.1%) and beta-blockers (85.9%). Residual cardiovascular risk following an acute coronary syndrome remains high despite advances in secondary prevention. A higher burden of comorbidities is associated with increased residual risk that may benefit from aggressive or novel therapies.
format	article
author	Pishoy Gouda Anamaria Savu Kevin R Bainey Padma Kaul Robert C Welsh
author_facet	Pishoy Gouda Anamaria Savu Kevin R Bainey Padma Kaul Robert C Welsh
author_sort	Pishoy Gouda
title	Long-term risk of death and recurrent cardiovascular events following acute coronary syndromes.
title_short	Long-term risk of death and recurrent cardiovascular events following acute coronary syndromes.
title_full	Long-term risk of death and recurrent cardiovascular events following acute coronary syndromes.
title_fullStr	Long-term risk of death and recurrent cardiovascular events following acute coronary syndromes.
title_full_unstemmed	Long-term risk of death and recurrent cardiovascular events following acute coronary syndromes.
title_sort	long-term risk of death and recurrent cardiovascular events following acute coronary syndromes.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/28b714938c7847b1b367db703dba3e12
work_keys_str_mv	AT pishoygouda longtermriskofdeathandrecurrentcardiovasculareventsfollowingacutecoronarysyndromes AT anamariasavu longtermriskofdeathandrecurrentcardiovasculareventsfollowingacutecoronarysyndromes AT kevinrbainey longtermriskofdeathandrecurrentcardiovasculareventsfollowingacutecoronarysyndromes AT padmakaul longtermriskofdeathandrecurrentcardiovasculareventsfollowingacutecoronarysyndromes AT robertcwelsh longtermriskofdeathandrecurrentcardiovasculareventsfollowingacutecoronarysyndromes
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Long-term risk of death and recurrent cardiovascular events following acute coronary syndromes.

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