Effect of myocardial revascularization upon long-term prognosis of patients with acute coronary syndrome and concomitant dıseases

Abstract

The aim – to assess the prognostic effect of myocardial revascularization in patients with acute coronary syndrome (ACS) with comorbidity or multimorbidity. Materials and methods. Event-free survival analysis according to simplified comorbidity index and treatment strategy of 337 consecutive patients with ACS using a composite endpoint of cardiac death and nonfatal myocardial infarction. Results. A total of 150 (45 %) patients were found to have comorbid conditions. Among them, the simplified comorbidity index (SCI) was 0 points in 187 (55 %), 1 – in 71 (21 %), ≥ 2 – in 79 (23 %) patients. During a median follow-up of 19 months, 29 (9 %) patients experienced a composite endpoint: 14 (4 %) cardiac deaths and 15 (5 %) nonfatal myocardial infarctions. A significant linear trend between SCI and event rate was observed (χ2 = 14.59, р = 0.0001). The prognostic effect of myocardial revascularization was not significantly different from the effect of conservative treatment (hazard ratio (HR) 0.75, 95 % confidence interval (CІ) 0.16–3.33, р = 0.68 in patients with a SCI = 0 points, HR 1.71, 95 % CІ 0.25–10.20, р = 0.61 in patients with a SCI = 1, and HR 0.65, 95 % CІ 0.23–1.284, р = 0.42 in patients with a SCI ≥ 2. Left ventricular ejection fraction, peripheral artery disease and SCI ≥ 2 predicted cardiac events in the study population. Conclusions. In the present study, invasive strategy as compared to the conservative treatment in patients with ACS with comorbidity or multimorbidity did not modify the long-term composite outcome in terms of cardiac death and nonfatal myocardial infarction

Keywords

• acute coronary syndrome
• comorbidity
• multimorbidity
• survival
• revascularization.