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The Prognosis of Coronary Artery Disease in a Brazilian Community Hospital: Findings from the ERICO Study
Tatiana Cristina Bruno1, Marcio Sommer Bittencourt1, Alessandra V L Quidim1
1Universidade de São Paulo, Hospital Universitário de São Paulo - Centro de Pesquisa Clínica e Epidemiológica, São Paulo, SP - Brasil.
Insights
Long-term prognosis after acute coronary syndrome (ACS) is linked to coronary artery disease (CAD) severity. Even one-vessel disease significantly increases long-term mortality risk post-ACS.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Long-term outcomes after acute coronary syndrome (ACS) in secondary care settings are not well-established.
- The prognostic value of coronary artery disease (CAD) severity for long-term mortality requires further investigation in community hospitals.
Purpose of the Study:
- To compare short- and long-term prognosis following ACS based on obstructive coronary artery disease severity.
- To evaluate mortality risks associated with different degrees of coronary artery obstruction in patients treated in a secondary care hospital.
Main Methods:
- Prospective cohort study (ERICO study) involving 800 adult patients.
- Survival analyses using Kaplan-Meier curves and Cox proportional hazard models over a 4-year follow-up.
- Assessment of all-cause, cardiovascular disease (CVD), and CAD mortality stratified by coronary artery obstruction (none, 1-vessel, 2-vessel, multivessel).
Main Results:
- Multivessel disease was associated with significantly poorer survival rates for all-cause, CVD, and CAD mortality (p-log rank < 0.0001).
- After multivariate adjustment, multivessel disease (HR: 2.33) and 1-vessel disease (HR: 2.44) presented the highest risks for all-cause mortality at 4 years compared to no obstruction.
- Increased risk of mortality was observed even with less severe coronary artery obstruction.
Conclusions:
- Both multivessel and 1-vessel disease indicate a high long-term mortality risk post-ACS.
- Emphasizes the need for improved cardiovascular risk management strategies, even for patients perceived as lower risk in secondary care settings.
Background:
Long-term prognosis post-acute coronary syndrome (ACS) in secondary care is not well-known. The severity of coronary artery disease (CAD) as a predictor of long-term mortality was evaluated in a community hospital in Brazil.
Objective:
We aimed to compare short and long-term prognosis after an ACS event according to severity of obstructive disease in patients attended in a secondary community hospital from prospective CAD cohort in Brazil (the Strategy of Registry of Acute Coronary Syndrome, ERICO study).
Methods:
Survival analyses were performed by Kaplan-Meier curves and Cox proportional hazard models (hazard ratios (HR) with respective 95% confidence interval (CI) to evaluate cumulative all-cause, CVD and CAD mortality according the coronary artery obstruction: no-obstruction (reference group), 1-vessel-disease, 2-vessel-disease, multivessel-disease) among 800 adults from an ERICO study during a 4-year-follow-up. HR are presented as crude and further adjusted for potential confounders from 180 days to 4-year follow-up after ACS. A p-value <0.05 was considered statistically significant.
Results:
Poorer survival rates were detected among individuals with multivessel-disease (all-cause, CVD and CAD, p-log rank< 0.0001). After multivariate adjustments, multivessel-disease |(HR; 2.33 (CI 95%; 1.10-4.95)) and 1-vessel-disease obstructed (HR; 2.44 (CI 95%; 1.11-5.34)) had the highest risk for all-cause mortality compared to those with no obstruction at 4-year follow-up.
Conclusions:
Not only multivessel-disease, but also 1-vessel-disease patients showed a high long-term mortality risk post-ACS. These findings highlight the importance of having a better approach in the treatment and control of cardiovascular risk even in apparently low-risk individuals attended to in secondary care.
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