open access

Vol 76, No 5 (2018)
Original articles
Published online: 2018-01-19
Submitted: 2017-12-11
Accepted: 2018-01-16
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Risk factors for adverse outcomes of patients with acute coronary syndrome: single-centre experience with long-term follow-up of treated patients

Marcin Grabowski, Krzysztof J. Filipiak, Grzegorz Opolski, Renata Główczyńska, Monika Gawałko, Paweł Balsam, Andrzej Cacko, Zenon Huczek, Grzegorz Karpiński, Robert Kowalik, Franciszek Majstrak, Janusz Kochman
DOI: 10.5603/KP.a2018.0031
·
Kardiol Pol 2018;76(5):881-888.

open access

Vol 76, No 5 (2018)
Original articles
Published online: 2018-01-19
Submitted: 2017-12-11
Accepted: 2018-01-16

Abstract

Background:

For patients experiencing an acute coronary syndrome (ACS), a crucial time to assess their prognosis and to plan management is at discharge from hospital.


Aim:

The aim of the study was to identify risk factors of mortality during post-discharge period following a hospitalisation for ACS.


Methods:

We studied 672 consecutive ACS patients hospitalised and discharged alive between 2002 and 2004. The analysis was done with respect to the type of ACS, i.e. unstable angina/non-ST-segment elevation myocardial infraction (UA/NSTEMI; n = 255) vs. ST-segment elevation myocardial infarction (STEMI; n = 417). All patients underwent coronary angiography and, if indicated, primary angioplasty (STEMI: 417 patients; UA/NSTEMI: 157 patients). The Cox proportional hazards regression model was used to evaluate the independent effect of the risk factors on the occurrence of primary endpoint, i.e. all-cause mortality during six-year follow-up. Survival status and date of death were obtained from the National Registry of Population (PESEL database).


Results:

A total of 123 patients (18.3%) died within the post-discharge period. The multivariate analysis identified 11 highly significant independent predictors of mortality (in order of predictive strength): diabetes mellitus (all types), higher creatinine level, older age, and more frequent occurrence of: supraventricular arrhythmias during hospitalisation, peripheral artery disease, recurrent angina pectoris with documented ischaemia on electrocardiogram, male sex, prior myocardial infarction, treatment with intra-aortic balloon pump counterpulsation, heart failure, and higher peak levels of creatine kinase-MB.


Conclusions:

The risk factors obtained from the medical history and during the hospitalisation improve the risk stratification during the post-discharge period after hospitalisation for ACS.

Abstract

Background:

For patients experiencing an acute coronary syndrome (ACS), a crucial time to assess their prognosis and to plan management is at discharge from hospital.


Aim:

The aim of the study was to identify risk factors of mortality during post-discharge period following a hospitalisation for ACS.


Methods:

We studied 672 consecutive ACS patients hospitalised and discharged alive between 2002 and 2004. The analysis was done with respect to the type of ACS, i.e. unstable angina/non-ST-segment elevation myocardial infraction (UA/NSTEMI; n = 255) vs. ST-segment elevation myocardial infarction (STEMI; n = 417). All patients underwent coronary angiography and, if indicated, primary angioplasty (STEMI: 417 patients; UA/NSTEMI: 157 patients). The Cox proportional hazards regression model was used to evaluate the independent effect of the risk factors on the occurrence of primary endpoint, i.e. all-cause mortality during six-year follow-up. Survival status and date of death were obtained from the National Registry of Population (PESEL database).


Results:

A total of 123 patients (18.3%) died within the post-discharge period. The multivariate analysis identified 11 highly significant independent predictors of mortality (in order of predictive strength): diabetes mellitus (all types), higher creatinine level, older age, and more frequent occurrence of: supraventricular arrhythmias during hospitalisation, peripheral artery disease, recurrent angina pectoris with documented ischaemia on electrocardiogram, male sex, prior myocardial infarction, treatment with intra-aortic balloon pump counterpulsation, heart failure, and higher peak levels of creatine kinase-MB.


Conclusions:

The risk factors obtained from the medical history and during the hospitalisation improve the risk stratification during the post-discharge period after hospitalisation for ACS.

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Keywords

acute coronary syndrome, long-term risk, prognosis after discharge

Supplementary Files (2)
Table S1. Detailed characteristics of study group.
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Appendix 1. A list of candidate predictor variables.
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About this article
Title

Risk factors for adverse outcomes of patients with acute coronary syndrome: single-centre experience with long-term follow-up of treated patients

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 76, No 5 (2018)

Pages

881-888

Published online

2018-01-19

DOI

10.5603/KP.a2018.0031

Bibliographic record

Kardiol Pol 2018;76(5):881-888.

Keywords

acute coronary syndrome
long-term risk
prognosis after discharge

Authors

Marcin Grabowski
Krzysztof J. Filipiak
Grzegorz Opolski
Renata Główczyńska
Monika Gawałko
Paweł Balsam
Andrzej Cacko
Zenon Huczek
Grzegorz Karpiński
Robert Kowalik
Franciszek Majstrak
Janusz Kochman

References (15)
  1. Bueno H, Fernández-Avilés F. Use of risk scores in acute coronary syndromes. Heart. 2012; 98(2): 162–168.
  2. Hamm CW, Bassand JP, Agewall S, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2011; 32(23): 2999–3054.
  3. Antman EM, Cohen M, Bernink PJ, et al. The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making. JAMA. 2000; 284(7): 835–842.
  4. Boersma E, Pieper KS, Steyerberg EW, et al. Predictors of outcome in patients with acute coronary syndromes without persistent ST-segment elevation. Results from an international trial of 9461 patients. The PURSUIT Investigators. Circulation. 2000; 101(22): 2557–2567.
  5. Fox KAA, Dabbous OH, Goldberg RJ, et al. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ. 2006; 333(7578): 1091–1094.
  6. Eagle KA, Lim MJ, Dabbous OH, et al. A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month postdischarge death in an international registry. JAMA. 2004; 291(22): 2727–2733.
  7. Thygesen K, Alpert JS, Jaffe AS, et al. Third Universal Definition of Myocardial Infarction. Circulation. 2012; 126(16): 2020–2035.
  8. Singh M, White J, Hasdai D, et al. Long-term outcome and its predictors among patients with ST-segment elevation myocardial infarction complicated by shock: insights from the GUSTO-I trial. J Am Coll Cardiol. 2007; 50(18): 1752–1758.
  9. Hochman JS, Apolito R. The calm after the storm: long-term survival after cardiogenic shock. J Am Coll Cardiol. 2007; 50(18): 1759–1760.
  10. Eagle KA, Lim MJ, Dabbous OH, et al. A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month postdischarge death in an international registry. JAMA. 2004; 291(22): 2727–2733.
  11. Tomaszuk-Kazberuk A, Kozuch M, Malyszko J, et al. Which method of GFR estimation has the best prognostic value in patients treated with primary PCI: Cockcroft-Gault formula, MDRD, or CKD-EPI equation?--A 6-year follow-up. Ren Fail. 2011; 33(10): 983–989.
  12. Lenarczyk R, Pruszkowska P, Morawski S, et al. Ultra-fast, high density 3D mapping (Rhythmia Mapping System) and catheter radiofrequency ablation for electrical storm – early single centre experience. Heart Beat J. 2017; 1: 35–40.
  13. Bangalore S, Messerli FH, Ou FS, et al. The association of admission heart rate and in-hospital cardiovascular events in patients with non-ST-segment elevation acute coronary syndromes: results from 135 164 patients in the CRUSADE quality improvement initiative. Eur Heart J. 2010; 31(5): 552–560.
  14. Avezum A, Piegas LS, Goldberg RJ, et al. Magnitude and prognosis associated with ventricular arrhythmias in patients hospitalized with acute coronary syndromes (from the GRACE Registry). Am J Cardiol. 2008; 102(12): 1577–1582.
  15. Scirica BM, Braunwald E, Belardinelli L, et al. Relationship between nonsustained ventricular tachycardia after non-ST-elevation acute coronary syndrome and sudden cardiac death: observations from the metabolic efficiency with ranolazine for less ischemia in non-ST-elevation acute coronary syndrome-thrombolysis in myocardial infarction 36 (MERLIN-TIMI 36) randomized controlled trial. Circulation. 2010; 122(5): 455–462.

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