Non-traditional predictors of adverse cardiovascular outcomes following acute coronary syndromes post-percutaneous coronary intervention

Abstract

BACKGROUND: Ischaemic heart disease is a major cause of morbidity and mortality but in the modern era of percutaneous coronary intervention (PCI), factors impacting on adverse cardiovascular outcomes may have altered. The aim of our study was to evaluate the clinical and echocardiographic determinants of adverse cardiovascular outcomes in patients with acute coronary syndromes (ACS) following PCI. METHODS: We performed a single centre retrospective study of patients admitted to our institution with ACS from Jan 2014 to Dec 2017. All patients who had coronary angiography were included and the composite outcome of cardiovascular (CV) death and re-infarction post intervention assessed. RESULTS: Of the 1185 patients (60.30±12.15years, 70% male) analysed, 10% presented with ST-elevation ACS while 90% had non ST-elevation ACS. In this cohort, 43% had single vessel disease and 57% had multi-vessel disease. Revascularisation was performed in 64% of patients; 85% with percutaneous coronary intervention and 15% with bypass grafting. Over a mean follow-up of 36.13±19.30months, 197 composite events were recorded (138 re-infarction, 59 CV death). Cox regression analysis showed chronic kidney disease (CKD; HR 2.425; 95%CI 1.233-4.771; p=0.01) and high echocardiographic E/e’ (HR 1.056; 95%CI 1.015-1.098; p<0.01) to be independently associated with the composite outcome. Revascularisation was associated with a reduction of the composite outcome (HR 0.563; 95%CI 0.355-0.892; p=0.01). CONCLUSIONS: CKD and high E/e’ are non-traditional factors that were independently associated with composite outcomes of CV death and re-infarction, whereas appropriate revascularisation is protective. More aggressive post-discharge therapy and surveillance in this group may lead to improved outcomes.