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Published on: January 28, 2020
Differential prognostic effect of revascularization according to a simple comorbidity index in high-risk
Patricia Palau1, Julio Núñez, Juan Sanchis
1Cardiology Department, Hospital Clinico Universitario, INCLIVA, Universidad de Valencia, Valencia, Spain. patri.palau@gmail.com
Insights
Revascularization significantly benefits high-risk patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) and multiple comorbidities, as identified by the Simple Comorbidity Index (SCI) score. The SCI score helps pinpoint patients who experience reduced long-term death or myocardial infarction risk after revascularization.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Limited data exists on revascularization's impact in high-risk non-ST-segment elevation acute coronary syndrome (NSTEACS) patients with comorbidities.
- The Simple Comorbidity Index (SCI) effectively stratifies risk based on five key comorbidities.
- Therapeutic implications of the SCI score in NSTEACS management remain underexplored.
Purpose of the Study:
- To assess the prognostic value of revascularization in NSTEACS patients stratified by the SCI score.
- To determine if the SCI score can identify NSTEACS patients who benefit most from revascularization.
Main Methods:
- A cohort of 1017 NSTEACS patients was analyzed.
- Revascularization's effect on a composite endpoint of all-cause mortality or nonfatal myocardial infarction (MI) was evaluated using Cox regression.
- Patients were categorized based on their SCI score (0, 1, or ≥2 comorbidities).
Main Results:
- Revascularization showed a significant prognostic benefit in patients with an SCI score of ≥2 (HR: 0.51, 95% CI: 0.29-0.89).
- No significant benefit from revascularization was observed in patients with SCI scores of 0 (HR: 1.31) or 1 (HR: 1.11).
- A significant interaction (P=0.008) indicated a differential prognostic effect of revascularization based on SCI score.
Conclusions:
- The SCI score is a valuable tool for identifying NSTEACS patients who achieve substantial long-term risk reduction in death/MI after revascularization.
- Revascularization is particularly beneficial for NSTEACS patients with multiple comorbidities (SCI ≥2).
- Risk stratification using the SCI score can guide therapeutic decisions regarding revascularization in NSTEACS.
Background:
Data on the effect of revascularization on outcome in patients with high-risk non-ST-segment elevation acute coronary syndrome (NSTEACS) and significant comorbidities are scarce. Recently, a simple comorbidity index (SCI) including 5 comorbidities (renal failure, dementia, peripheral artery disease, heart failure, and prior myocardial infarction [MI]) has shown to be a useful tool for risk stratification. Nevertheless, therapeutic implications have not been derived.
Hypothesis:
We sought to evaluate the prognostic effect attributable to revascularization in NSTEACS according the SCI score.
Methods:
We included 1017 consecutive patients with NSTEACS. The effect of revascularization on a combined end point of all-cause mortality or nonfatal MI was evaluated by Cox regression according to SCI categories.
Results:
A total of 560 (55.1%), 236 (23.2%), and 221 (21.7%) patients showed 0, 1, and ≥2 points according to the SCI, respectively. Coronary angiography was performed in 725 patients (71.5%), and 450 patients (44.3%) underwent revascularization. During a median follow-up of 16 months (interquartile range, 12-36 months), 305 (30%) patients experienced the combined end point (202 deaths [19.9%] and 170 MIs [16.7%]). In multivariate analysis, a differential prognostic effect of revascularization was observed comparing SCI ≥2 vs 0 (P for interaction = 0.008). Thus, revascularization was associated with a greater prognostic benefit in patients with SCI ≥2 (hazard ratio [HR]: 0.51, 95% confidence interval [CI]: 0.29-0.89), P = 0.018), whereas no significant benefit was observed in those with 0 and 1 point (HR: 1.31, 95% CI: 0.88-1.94, P = 0.171 and HR: 1.11, 95% CI: 0.70-1.76, P = 0.651, respectively).
Conclusions:
In NSTEACS, the SCI score appears to be a useful tool for identifying a subset of patients with a significant long-term death/MI risk reduction attributable to revascularization.
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