[Acute Coronary Syndrome Registry of High Risk Patients: 30-Day Outcome]

Area of Science:

• Cardiology
• Clinical Research
• Vascular Medicine

Background:

• Acute coronary syndrome (ACS) poses a significant risk for major adverse cardiac events (MACE).
• Real-world data often reveal higher mortality rates in ACS patients compared to clinical trials, particularly in elderly populations with high comorbidity.
• Identifying additional cardiovascular risk factors beyond traditional ones is crucial for effective MACE risk stratification.

Purpose of the Study:

• To evaluate additional cardiovascular risk factors for MACE in ACS patients within 30 days post-index event.
• To assess the role of platelet function testing (PFT) in risk stratification for ACS patients.
• To analyze the impact of chronic kidney disease and type 2 myocardial infarction (T2MI) on MACE in ACS.

Main Methods:

• Prospective registry of 750 ACS patients from 2012-2015.
• Dual antiplatelet therapy administered to 569 patients; PFT performed in 425.
• Analysis included univariate and multivariate assessments of MACE predictors.

Main Results:

• 30-day mortality rate was 10.1%.
• Univariate analysis linked MACE to age, atrial fibrillation, stroke, chronic kidney disease, low ejection fraction, and T2MI.
• Multivariate analysis identified high-on-treatment platelet reactivity (PFT > 45%), chronic kidney disease, and T2MI as significant MACE predictors.

Conclusions:

• The ACS registry highlights high real-world mortality, linked to elderly patients and high comorbidity.
• Type 2 myocardial infarction (T2MI) and chronic kidney disease are associated with a more severe prognosis and increased MACE.
• Platelet function testing (PFT) is valuable for risk stratification in ACS patients, especially those with T2MI and chronic kidney disease.