[Predictive factors of recurrent acute coronary syndrome]

The recurrence of acute coronary syndrome (ACS) represents a major public health issue due to its significant contribution to cardiovascular morbidity and mortality. Despite therapeutic advances in interventional cardiology, a substantial proportion of patients remains at risk of recurrent ACS. The objective of our study was to identify predictive factors for ACS recurrence.

We conducted a single-center, observational, retrospective, etiological study between January 2017 and December 2023. A total of 224 patients were included, of whom 107 experienced recurrent ACS, while 117 presented with only one episode. Clinical and paraclinical data were collected from medical records and univariate and multivariate statistical analyses were performed.

The mean age of the study population was 60.01±10.69 years, with a male predominance (79%). Statistical analyses showed that patients with recurrent ACS had a significantly higher number of cardiovascular risk factors (3.89±1.36 vs 2.91±1.17; OR=3.43, 95% CI: 1.79-6.57; P<0.001), particularly smoking (83.2% vs 70.9%, OR=2.03; 95% CI: 1.07-3.87; P=0.015), diabetes (60.7% vs 45.3%, OR=1.87; 95% CI: 1.10-3.18; P=0.021), and hypertension (51.4% vs 36.8%, OR=2.07; 95% CI: 1.22-3.55; P=0.027). Moreover, multivessel disease (57.9% vs 42.7%, OR=1.84; 95% CI: 1.08-3.13; P=0.035), low HDL cholesterol levels (0.31 vs 0.35g/L, OR=2.07; 95% CI: 1.04-4.14; P=0.006), elevated C-reactive protein levels (14.75 vs 8.2mg/L, OR=2.10; 95% CI: 1.11-3.98; P=0.018), implantation of two or more stents (40% vs 13.6%, OR=4.05; 95% CI: 2.04-8.03; P<0.001), suboptimal angioplasty outcomes (9.5% vs 1.9%, OR=2.13; 95% CI: 1.83-2.48; P=0.021), and poor medication adherence (50.5% vs 26.2%, OR=2.96; 95% CI: 1.68-5.17; P=0.001) were more frequent among patients with recurrent ACS. Multivariate analysis revealed that diabetes, elevated CRP levels, and implantation of two or more stents were independently associated with ACS recurrence.

This study identified predictive factors for ACS recurrence. Diabetes, inflammation, and multi-stenting were independently associated with recurrence. These results highlight the importance of strict management of metabolic and inflammatory factors, as well as the optimization of revascularization strategies.