Long-term analysis in acute coronary syndrome: are there any differences in morbidity and mortality?
Adolfo Alexandre Farah de Aguiar1, Ricardo Mourilhe-Rocha, Roberto Esporcatte
1Universidade do Estado do Rio de Janeiro - Hospital Universitário Pedro Ernesto, Rio de Janeiro, RJ - Brazil.
Insights
Heart failure (HF) and elevated creatinine, age, and heart rate (HR) predict mortality in acute coronary syndrome (ACS) patients. Improved survival after 2002 is linked to updated therapies.
Area of Science:
- Cardiology
- Clinical Medicine
- Public Health
Background:
- Heart failure (HF) is a significant predictor of morbidity and mortality in patients with acute coronary syndrome (ACS).
- Understanding long-term outcomes in ACS is crucial for patient management and risk stratification.
Purpose of the Study:
- To identify and evaluate the long-term predictors of morbidity and mortality in patients diagnosed with acute coronary syndrome (ACS).
Main Methods:
- A cohort study involving 403 patients presenting with chest pain.
- Data collected included demographics, clinical status, laboratory results, and treatment details.
- Patients were followed for up to eight years post-discharge to assess cardiovascular events and mortality.
Main Results:
- Of 377 ACS patients (mean age 62.2 years, 37.9% female), HF presence before or during hospitalization impacted mortality.
- Independent predictors of mortality included initial creatinine level (cutoff 1.4 mg/dl), increasing age, and elevated heart rate (HR).
- Therapies like beta-blockers, ACEIs, statins, and antiplatelet agents, particularly after 2002, influenced mortality rates.
Conclusions:
- Heart failure upon admission, creatinine levels, age, and heart rate are independent predictors of mortality in ACS patients.
- Patients with HF treated before 2002 exhibited worse survival rates compared to those treated after 2002, attributed to changes in therapeutic strategies.
Background:
Heart failure (HF) is extremely important as a predictor of morbidity and mortality in patients with acute coronary syndrome (ACS).
Objective:
To evaluate the predictors of morbidity and mortality in ACS in the long term.
Methods:
A cohort study of 403 consecutive patients with complaints of chest pain. Demographic, clinical, laboratory and therapy-related data were described and the patients were evaluated during hospitalization and for up to eight years after being discharged, for the presence or absence or cardiovascular events and deaths.
Results:
There were 403 patients complaining of chest pain, 65.8% of whom had been diagnosed as having ACS without ST elevation, 27.8% had ACS with ST elevation and 6.5% without ACS. Among such patients, the 377 patients with ACS were evaluated (37.9% of whom were females), and the mean age was 62.2 ± 11.6 years. The presence of HF before or during hospitalization influenced mortality. Among the prognostic factors, emphasis should be placed on the initial creatinine level, with the cutoff point being set at 1.4 mg/dl (accuracy = 62.1%, HR = 3.27; p < 0.001). We noted a worse prognosis for each additional ten years of age (HR = 1.37, p < 0.001) and for each increment of 10 bpm heart rate (HR = 1.22 p < 0.001). As for the therapies used before and after 2002, there was an increase of beta-blockers, angiotensin-converting enzyme inhibitors (ACEIs), statins and antiplatelet agents, having an impact on mortality.
Conclusion:
HF upon admission, creatinine, age and HR were independent predictors of mortality. It was observed that HF patients treated before 2002 had a worse survival when compared with that seen after 2002 and the change in therapy was responsible for it.
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