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Risk factors for major adverse cardiovascular events after the first acute coronary syndrome
Marjo Okkonen1,2, Aki S Havulinna3,4, Olavi Ukkola1,2
1Research Unit of Internal Medicine, University of Oulu, Oulu, Finland.
Insights
Major adverse cardiac events (MACE) affect nearly half of acute coronary syndrome (ACS) survivors within three years. Diabetes, heart failure, and higher comorbidity scores significantly increase MACE risk in these patients.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Acute coronary syndrome (ACS) survivors face a significant risk of recurrent cardiovascular events.
- Understanding the risk factors for major adverse cardiac events (MACE) post-ACS is crucial for improving patient outcomes.
- Prevalence of modifiable risk factors in post-ACS patients requires investigation.
Purpose of the Study:
- To identify risk factors for MACE after a first ACS.
- To determine the prevalence of cardiovascular risk factors in patients post-ACS.
Main Methods:
- Utilized the Finnish myocardial infarction register (FINAMI) for ACS survivors (n=12,686) from 1993-2011.
- Followed up patients for three years to record recurrent events and mortality.
- Analyzed Finnish FINRISK survey data (n=199) for risk factor prevalence (smoking, lipids, diabetes, blood pressure).
Main Results:
- 48.4% of first ACS survivors experienced MACE within three years; 17.0% were fatal.
- Key MACE predictors included diabetes, heart failure during hospitalization, higher Charlson index, and older age.
- Revascularization was associated with a reduced risk of MACE.
- High prevalence of ongoing smoking (23%) and hyperlipidemia (24%) persisted despite medication use.
Conclusions:
- Diabetes, heart failure, and higher comorbidity burden are critical MACE risk factors post-ACS.
- Cardiovascular risk factors remain inadequately controlled in many ACS survivors.
- Targeted interventions are needed to manage risk factors and reduce MACE in this population.
Aims:
To evaluate risk factors for major adverse cardiac event (MACE) after the first acute coronary syndrome (ACS) and to examine the prevalence of risk factors in post-ACS patients.
Methods:
We used Finnish population-based myocardial infarction register, FINAMI, data from years 1993-2011 to identify survivors of first ACS (n = 12686), who were then followed up for recurrent events and all-cause mortality for three years. Finnish FINRISK risk factor surveys were used to determine the prevalence of risk factors (smoking, hyperlipidaemia, diabetes and blood pressure) in post-ACS patients (n = 199).
Results:
Of the first ACS survivors, 48.4% had MACE within three years of their primary event, 17.0% were fatal. Diabetes (p = 4.4 × 10-7), heart failure (HF) during the first ACS attack hospitalization (p = 6.8 × 10-15), higher Charlson index (p = 1.56 × 10-19) and older age (p = .026) were associated with elevated risk for MACE in the three-year follow-up, and revascularization (p = .0036) was associated with reduced risk. Risk factor analyses showed that 23% of ACS survivors continued smoking and cholesterol levels were still high (>5mmol/l) in 24% although 86% of the patients were taking lipid lowering medication.
Conclusion:
Diabetes, higher Charlson index and HF are the most important risk factors of MACE after the first ACS. Cardiovascular risk factor levels were still high among survivors of first ACS.
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