Poor long-term outcome in acute coronary syndrome in a real-life setting: Ten-year outcome of the TACOS study
Abstract
Background: Long-term outcome of the three categories of acute coronary syndrome (ACS) in real-life patient cohorts is not well known. The objective of this study was to survey the 10-year outcome of an ACS patient cohort admitted to a university hospital and to explore factors affecting the outcome.
Methods: A total of 1188 consecutive patients (median age 73 years) with ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI) or unstable angina pectoris (UA) in 2002–2003 were included and followed up for ≥ 10 years.
Results: Mortality for STEMI, NSTEMI and UA patients during the follow-up period was 52.5%, 69.9% and 41.0% (p < 0.001), respectively. In multivariable Cox regression analysis, only age and creatinine level at admission were independently associated with patient outcome in all the three ACS categories when analyzed separately.
Conclusions: All the three ACS categories proved to have high mortality rates during long-term followup in a real-life patient cohort. NSTEMI patients had worse outcome than STEMI and UA patients during the whole follow-up period. Our study results indicate clear differences in the prognostic significance of various demographic and therapeutic parameters within the three ACS categories.
Keywords: acute coronary syndromemyocardial infarctionprognosisunstable angina
References
- World Health Oranization. The top 10 causes of death. 2017. . http://www.who.int/mediacentre/factsheets/fs310/en/ (accessed 25 Jan 2018).
- Zeymer U, Senges J. Why do we need prospective registries in patients with acute myocardial infarction? Eur Heart J. 2003; 24(18): 1611–1612.
- Fach A, Bünger S, Zabrocki R, et al. Comparison of Outcomes of Patients With ST-Segment Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention Analyzed by Age Groups (<75, 75 to 85, and >85 Years); (Results from the Bremen STEMI Registry). Am J Cardiol. 2015; 116(12): 1802–1809.
- Bromage DI, Jones DA, Rathod KS, et al. Outcome of 1051 Octogenarian Patients With ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: Observational Cohort From the London Heart Attack Group. J Am Heart Assoc. 2016; 5(6).
- Nauta ST, Deckers JW, Akkerhuis KM, et al. Age-dependent care and long-term (20 year) mortality of 14,434 myocardial infarction patients: changes from 1985 to 2008. Int J Cardiol. 2013; 167(3): 693–697.
- Capewell S, Murphy NF, MacIntyre K, et al. Short-term and long-term outcomes in 133,429 emergency patients admitted with angina or myocardial infarction in Scotland, 1990-2000: population-based cohort study. Heart. 2006; 92(11): 1563–1570.
- Cox DA, Stone GW, Grines CL, et al. Comparative early and late outcomes after primary percutaneous coronary intervention in ST-segment elevation and non-ST-segment elevation acute myocardial infarction (from the CADILLAC trial). Am J Cardiol. 2006; 98(3): 331–337.
- Nikus KC, Eskola MJ, Virtanen VK, et al. Mortality of patients with acute coronary syndromes still remains high: a follow-up study of 1188 consecutive patients admitted to a university hospital. Ann Med. 2007; 39(1): 63–71.
- Fox KAA, Carruthers KF, Dunbar DR, et al. Underestimated and under-recognized: the late consequences of acute coronary syndrome (GRACE UK-Belgian Study). Eur Heart J. 2010; 31(22): 2755–2764.
- Moscarella E, Spitaleri G, Brugaletta S, et al. Impact of body mass index on 5-year clinical outcomes in patients with ST-segment elevation myocardial infarction after everolimus-eluting or bare-metal stent implantation. Am J Cardiol. 2017; 120(9): 1460–1466.
- Fox KAA, Eagle KA, Gore JM, et al. GRACE and GRACE2 Investigators. The Global Registry of Acute Coronary Events, 1999 to 2009--GRACE. Heart. 2010; 96(14): 1095–1101.
- Ellis CJ, Gamble GD, Williams MJA, et al. Regional Cardiac Society NZ ACS Audit Group. All-Cause Mortality Following an Acute Coronary Syndrome: 12-Year Follow-Up of the Comprehensive 2002 New Zealand Acute Coronary Syndrome Audit. Heart Lung Circ. 2019; 28(2): 245–256.
- Plakht Y, Shiyovich A, Gilutz H. Predictors of long-term (10-year) mortality postmyocardial infarction: age-related differences. Soroka Acute Myocardial Infarction (SAMI) Project. J Cardiol. 2015; 65(3): 216–223.
- Elgendy IY, Mahmoud AN, Wen X, et al. Meta-Analysis of Randomized Trials of Long-Term All-Cause Mortality in Patients With Non-ST-Elevation Acute Coronary Syndrome Managed With Routine Invasive Versus Selective Invasive Strategies. Am J Cardiol. 2017; 119(4): 560–564.
- Alexander KP, Newby LK, Cannon CP, et al. American Heart Association Council on Clinical Cardiology, Society of Geriatric Cardiology. Acute coronary care in the elderly, part I: Non-ST-segment-elevation acute coronary syndromes: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology. Circulation. 2007; 115(19): 2549–2569.
- Cohen M. Long-term outcomes in high-risk patients with non-ST-segment elevation myocardial infarction. J Thromb Thrombolysis. 2016; 41(3): 464–474.
- Darling CE, Fisher KA, McManus DD, et al. Survival after hospital discharge for ST-segment elevation and non-ST-segment elevation acute myocardial infarction: a population-based study. Clin Epidemiol. 2013; 5: 229–236.
- Radovanovic D, Nallamothu BK, Seifert B, et al. Temporal trends in treatment of ST-elevation myocardial infarction among men and women in Switzerland between 1997 and 2011. Eur Heart J Acute Cardiovasc Care. 2012; 1(3): 183–191.
- Rogers WJ, Frederick PD, Stoehr E, et al. Trends in presenting characteristics and hospital mortality among patients with ST elevation and non-ST elevation myocardial infarction in the National Registry of Myocardial Infarction from 1990 to 2006. Am Heart J. 2008; 156(6): 1026–1034.
- Helft G, Georges JL, Mouranche X, et al. Outcomes of primary percutaneous coronary interventions in nonagenarians with acute myocardial infarction. Int J Cardiol. 2015; 192: 24–29.
- Barchielli A, Santoro GM, Balzi D, et al. Long-term prognosis after primary PCI in unselected patients with ST-elevation myocardial infarction. J Cardiovasc Med (Hagerstown). 2012; 13(12): 819–827.
- Polonski L, Gasior M, Gierlotka M, et al. A comparison of ST elevation versus non-ST elevation myocardial infarction outcomes in a large registry database: are non-ST myocardial infarctions associated with worse long-term prognoses? Int J Cardiol. 2011; 152(1): 70–77.
- Roffi M, Patrono C, Collet JP, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016; 37(3): 267–315.
- Bucholz EM, Butala NM, Rathore SS, et al. Sex differences in long-term mortality after myocardial infarction: a systematic review. Circulation. 2014; 130(9): 757–767.
- Erdem G, Bakhai A, Taneja AK, et al. Rates and causes of death from non-ST elevation acute coronary syndromes: ten year follow-up of the PRAIS-UK registry. Int J Cardiol. 2013; 168(1): 490–494.
- Prami T, Khanfir H, Deleskog A, et al. Clinical factors associated with initiation of and persistence with ADP receptor-inhibiting oral antiplatelet treatment after acute coronary syndrome: a nationwide cohort study from Finland. BMJ Open. 2016; 6(11): e012604.
- Hvelplund A, Galatius S, Madsen M, et al. Significance of the invasive strategy after acute myocardial infarction on prognosis and secondary preventive medication: a nationwide study of 6364 women and 11,915 men. J Invasive Cardiol. 2012; 24(1): 19–24.