Predictors of Five-Year Outcomes in Patients with Acute Coronary Syndromes

Area of Science:

• Cardiology
• Internal Medicine
• Vascular Biology

Background:

• Residual risk after acute coronary syndromes (ACS) impacts patient prognosis.
• Investigating factors like female sex, non-ST-segment-elevation myocardial infarction (NSTEMI), diabetes mellitus (DM), and chronic kidney disease (CKD) is crucial for understanding coronary atherosclerosis extent, culprit stenosis location, and bio-humoral data.
• Evaluating major adverse cardiovascular events (MACE) and non-fatal recurrent coronary events (RCE) provides further insight into patient outcomes.

Purpose of the Study:

• To assess the impact of NSTEMI, DM, CKD, and sex on coronary atherosclerosis and bio-humoral markers in ACS patients.
• To determine the predictive value of these factors for MACE and RCE over a 5-year follow-up period.

Main Methods:

• 1404 ACS patients were enrolled and followed for up to 5 years.
• Coronary angiography was used to analyze culprit and non-culprit stenoses.
• Bio-humoral data was collected at admission, 1 month, and 12 months post-discharge, with comparisons made based on sex, NSTEMI, DM, and CKD status.

Main Results:

• NSTEMI patients exhibited a higher number of total and non-culprit stenoses, with greater non-culprit percent stenosis compared to STEMI patients.
• DM patients had more bifurcation lesions, while CKD patients showed a higher prevalence of left main disease.
• Female patients had elevated LDL-cholesterol levels at 1 and 12 months post-discharge. NSTEMI, DM, and creatinine levels independently predicted MACE, and NSTEMI patients faced an increased risk of non-fatal RCE.

Conclusions:

• NSTEMI, DM, and admission creatinine levels are independent predictors of MACE within the first five years post-ACS.
• These findings highlight key risk factors that warrant close monitoring and management in ACS survivors.