Hemodynamic Markers Predict Outcomes a Decade After Acute Coronary Syndrome

Background: Previous research from our group demonstrated that novel hemodynamic indices can predict 3-5-year mortality risk in myocardial infarction survivors. Building on these findings, we assessed the long-term prognostic value of these markers over a 10-year follow-up period. Methods: We conducted a prospective study involving 569 consecutive acute coronary syndrome (ACS) patients admitted within 12 h of symptom onset, all presenting with >50% coronary artery stenosis. Hemodynamic indices were assessed using echocardiography to measure ejection fraction (EF), global longitudinal peak systolic strain (GLPSS), and ventricular-arterial coupling (VA coupling). Excess aortic pressure (excess_PTI) was evaluated via radial tonometry, while local arterial stiffness was assessed by pulse wave velocity (PWV) through carotid ultrasonography. The primary outcome was all-cause mortality over a 10-year follow-up period. Results: Over a median follow-up of 3249 days, 172 patients reached the primary endpoint (death). Deceased individuals were older and exhibited lower EF, impaired VA coupling, higher excess_PTI, and a lower PWV/GLPSS index compared to survivors. In multivariate Cox proportional hazards analysis, EF, VA coupling, excess_PTI, and PWV/GLPSS index were independently associated with all-cause mortality over a 10-year follow-up period. Conclusions: This study highlights the significant long-term prognostic value of novel hemodynamic indices, including VA coupling, PWV/GLPSS index, and excess_PTI, in predicting 10-year all-cause mortality in ACS patients.