Abstract
Background
Trends in 30-day mortality after acute coronary syndromes (ACS) continue downward, however data on long-term outcomes are limited. We measured the risk of major adverse cardiovascular events (MACE) at 5-years following ACS, stratified by subtype.
Methods
We identified all 30-day survivors of ACS hospitalisation in WA from 2002–2019 from linked hospital/mortality collections. The first admission for each patient was included and classified as STEMI, NSTEMI or unstable angina (UA). Primary outcome was MACE (nonfatal MI, stroke or CVD death). 5-year risk of MACE was estimated from Kaplan–Meier survival analyses, separately for 3 calendar-year periods. Multivariable Cox models were used to compare risk over time for each subtype.
Results
The cohort comprised 72,499 ACS patients, 65.1% males, with 22% STEMI, 43% NSTEMI and 34% UA; mean age 64.6 yrs in men, 70.8 yrs in women. NSTEMI patients had higher levels of prior MI, heart failure, diabetes, hypertension and AF at baseline. Unadjusted 5-year risk of MACE was highest in NSTEMI patients throughout, and was 5% lower for STEMI patients admitted in 2014–2019 vs those admitted in 2002–2007 (log-rank p<0.0001) and 7% lower in NSTEMI and UA by 2014-2019 (Table). After adjustment for age and comorbidities, the risk of MACE was significantly lower in NSTEMI and UA by the 2014-2019 period.
Conclusion
Our data highlight declining long-term risk of MACE across ACS subtypes, especially NSTEMI and UA, potentially indicating improved secondary prevention and/or lower severity of disease.
Trends in 30-day mortality after acute coronary syndromes (ACS) continue downward, however data on long-term outcomes are limited. We measured the risk of major adverse cardiovascular events (MACE) at 5-years following ACS, stratified by subtype.
Methods
We identified all 30-day survivors of ACS hospitalisation in WA from 2002–2019 from linked hospital/mortality collections. The first admission for each patient was included and classified as STEMI, NSTEMI or unstable angina (UA). Primary outcome was MACE (nonfatal MI, stroke or CVD death). 5-year risk of MACE was estimated from Kaplan–Meier survival analyses, separately for 3 calendar-year periods. Multivariable Cox models were used to compare risk over time for each subtype.
Results
The cohort comprised 72,499 ACS patients, 65.1% males, with 22% STEMI, 43% NSTEMI and 34% UA; mean age 64.6 yrs in men, 70.8 yrs in women. NSTEMI patients had higher levels of prior MI, heart failure, diabetes, hypertension and AF at baseline. Unadjusted 5-year risk of MACE was highest in NSTEMI patients throughout, and was 5% lower for STEMI patients admitted in 2014–2019 vs those admitted in 2002–2007 (log-rank p<0.0001) and 7% lower in NSTEMI and UA by 2014-2019 (Table). After adjustment for age and comorbidities, the risk of MACE was significantly lower in NSTEMI and UA by the 2014-2019 period.
Conclusion
Our data highlight declining long-term risk of MACE across ACS subtypes, especially NSTEMI and UA, potentially indicating improved secondary prevention and/or lower severity of disease.
Original language | English |
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Journal | Heart, Lung & Circulation |
Volume | 33 |
Issue number | Suppl 4 |
DOIs | |
Publication status | Published - Aug 2024 |
Event | 72nd Annual Scientific Meeting of the Cardiac Society of Australia and New Zealand: CSANZ 2024 - Perth Convention and Exhibition Centre, Perth, Australia Duration: 1 Aug 2024 → 4 Aug 2024 |