Predictors of 90-day outcome in patients stabilized after acute coronary syndromes

Area of Science:

• Cardiology
• Clinical Research
• Outcomes Research

Background:

• Patients surviving the acute phase of acute coronary syndrome (ACS) remain at risk for adverse events.
• Identifying these high-risk patients is crucial for targeted interventions and improved outcomes.

Purpose of the Study:

• To investigate predictors of 90-day risk for death, myocardial infarction (MI), and severe recurrent ischemia (SRI) in stabilized ACS patients.
• To develop and validate risk models for these composite endpoints.

Main Methods:

• Utilized data from 15,904 stabilized ACS patients from the SYMPHONY and 2nd SYMPHONY trials.
• Employed Cox proportional-hazards models to identify predictors from 118 demographic, historical, clinical, and medication variables.
• Validated models using individual trial models, backward elimination, and bootstrapping.

Main Results:

• Seventeen variables independently predicted 90-day mortality, with greater age, higher randomization heart rate, and heart failure (HF) variables showing the strongest associations.
• Higher creatinine clearance and percutaneous coronary intervention (PCI) between qualifying event and randomization were strong predictors of lower risk.
• Similar predictors emerged for composite endpoints of death or MI, and death, MI, or SRI, though HF variables and age were less strongly associated with these non-fatal outcomes.

Conclusions:

• Risk stratification is feasible for stabilized ACS patients within 90 days post-discharge.
• Traditional clinical markers are more effective in predicting mortality than non-fatal MI or SRI.
• Novel risk markers are needed to improve prediction of non-fatal ischemic events and severe recurrent ischemia in ACS patients.