Background Acute coronary syndrome (ACS) remains a significant cause of death and morbidity worldwide, and despite advancements in the identification and treatment of modifiable risk factors many patients remain exposed to a high-risk of recurrent events. Co-morbidities such as hypercholesterolaemia, hypertension and diabetes mellitus are established vascular risk factors that are identifiable at presentation. Routine follow-up may guide the use of novel treatment strategies including prolonged use of anti-thrombotics, sodium-glucose co-transport-2 (SGLT2) inhibitors, and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, recommended by ESC guidelines.
Methods To assess the clinical practice of lipid, glycaemic and blood pressure control in high-risk patients following an ACS. A retrospective analysis of 62 high-risk patients who had known vascular risk factors who had ACS between January and June 2017. Data on lipid profile, blood pressure, glycaemic control, and medications were captured at the following timelines: prior to ACS presentation, during admission, at 6-months, 12-months, and 24-months with subsequent descriptive analysis.
Results Among 62 eligible patients, 60% (37) were smokers; 38% (23) had hyperlipidaemia; 36% (22) had hypertension; 13% (8) had Type 2 diabetes and 3% (2) had chronic kidney disease. 37% (23) had single vessel disease, 36% (22) had double vessel disease and 26% (16) had triple vessel disease. 97% (60) had revascularisation. Mean LDL levels at baseline, 6-months, 12-months and 24-months were: 3.1 mmol/L, 2.3 mmol/L, 1.8 mmol/L and 2.0 mmol/L respectively (Table 1). The proportion of patients with LDL level over 1.4 mmol/L at 12-months was 34% (21), of whom 31% (19) were already on high-intensity statins. Patients on dual antiplatelet therapy was 68% (42) at 6-months and 13% (8) at 12-months whilst SGLT2i usage was (2%) at 12-months. At 12-months 19% (12) patients had HbA1c >47 mmol/mol and 40% (24) of patients with systolic blood pressure >130 mmHg at 12-months. Within 2-years, 15% (9) of patients had a subsequent ACS event and 4 patients had further revascularisation procedure including one coronary artery bypass graft.
Conclusion This retrospective analysis has shown that there were unmet needs to reduce residual cardiovascular risk in patients with recent ACS. Around one-third of patients would benefit from more intensive management of traditional cardiovascular risk factors with the use of newer therapies suggested by ESC guidelines.
Conflict of Interest None to Declare
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