[Acute Coronary Syndrome Registry of High Risk Patients: 30-Day Outcome]
N V Lomakin1, L I Buryachkovskaya2, A B Sumarokov2
1Central Clinical Hospital of the Management Affair of President RF.
Insights
High-on-treatment platelet reactivity, chronic kidney disease, and type 2 myocardial infarction (T2MI) significantly increase major adverse cardiac events (MACE) risk in acute coronary syndrome (ACS) patients within 30 days. Platelet function testing (PFT) aids risk stratification.
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.
Aim:
The aim of the study is to evaluate important additional cardiovascular (CV) risk factors of major adverse cardiac events (MACE) in patients with acute coronary syndrome (ACS) during the first 30 days after index event.
Materials And Methods:
Overall 750 patients with ACS were enrolled in the single center prospective registry from 2012-2015yy. 569 patients received dual antiplatelet therapy and in 425 cases platelet function testing (PFT) were performed. Most of the patients characterized as high risk elderly patients with multiple CV risk factors and high comorbidity index.
Results:
At 30-day follow-up the mortality rate was 10,1%. Singlevariate analysis showed strong association between MACE and age, atrial fibrillation, stroke, chronic kidney disease, low ejection fraction, type 2 myocardial infarction (T2MI). Multivariate analysis showed that high-on-treatment platelet reactivity (PFT> 45%) with odds ratio 4.418 (p=0.0001), chronic kidney disease (OR 6.538 p=0.001) and T2MI (OR 1.925 p=0.0001) were significantly associated with adverse outcome.
Conclusion:
ACS registry showed high mortality level in real-life practice compared with randomized clinical trials due to the high prevalence of elderly patients with high comorbidity index. Patients with T2MI have significantly more severe prognosis and chronic kidney disease associated with increased MACE. PFT in this category of patients is reasonable for more accurate risk stratification.
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