Objectives Cardiovascular (CV) disease is the leading cause of mortality in the US and worldwide; thus, it is important to understand the disease sequelae and prognostic predictors to help improve patient outcomes and reduce healthcare costs.
Methods Hospitalised patients with an ICD-9 code consistent with the diagnosis of acute coronary syndrome (ACS) were identified from the HealthCore Integrated Research Database (HIRDSM) between January 2006 and September 2011. A multivariable Cox proportional hazards model was used to evaluate the effect of risk factors on time to first subsequent CV event (defined as stroke, myocardial infarction or coronary heart disease-related mortality), adjusting for baseline demographic characteristics, comorbidities, treatment utilisation and index ACS characteristics.
Results Of 140,903 ACS patients identified, mean age was 66.8 years, 58.6% were male, and mean follow-up was 1.9 years. Baseline comorbidities include 41.9% with type 1 or 2 diabetes mellitus (DM), 60.4% hypertension (HTN), 10.7% renal dysfunction and 3.3% prior CABG/PCI. During the index ACS hospitalisation, 42.7% had unstable angina, 40.3% CABG and/or PCI and 3.6% of patients died. A total of 22.0% of patients had a recurrent CV event following index ACS, with an increased adjusted hazard of a recurrent event if the patient was older (hazard ratio [HR] = 1.48 in > 65 versus < 65 years), had a history of heart failure (HR = 1.41), renal dysfunction (HR = 1.36), HTN (HR = 1.14) or DM (HR = 1.10), all P < 0.001. Additionally, patients had a decreased adjusted hazard of a recurrent CV event with pre-admission single or fixed-dose combination statin use (HR = 0.96 and 0.87, respectively) or a CABG prior to admission (HR = 0.89), all P < 0.001.
Conclusions Following an ACS event, patients with pre-admission statin use or a prior CABG had decreased risk, while older patients or those with baseline comorbidities had increased risk of an adverse CV event occurring sooner. Ultimately, identifying high-risk ACS subgroups may facilitate tailored and more aggressive treatment to improve outcomes.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.