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Title: One-Year Outcomes of Patients With Established Coronary Artery Disease Presenting With Acute Coronary Syndromes.
Austin Authors: Murphy, Alexandra;Hamilton, Garry;Andrianopoulos, Nick;Yudi, Matias B ;Farouque, Omar ;Duffy, Stephen J;Lefkovits, Jeffrey;Brennan, Angela;Reid, Christopher M;Ajani, Andrew E;Clark, David J 
Affiliation: School of Public Health, Curtin University, Perth, Western Australia
University of Melbourne, Melbourne, Australia
Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia
Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Australia
Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
Issue Date: May-2019 2019-02-07
Publication information: The American journal of cardiology 2019; 123(9): 1387-1392
Abstract: The risk of major adverse cardiovascular events (MACE) remains high in patients with established coronary artery disease (CAD). The aim of this study was to assess the prognostic significance of established CAD in patients who present with acute coronary syndromes (ACS) using a large established multicenter registry. Consecutive patients from the Melbourne Interventional Group registry who presented with ACS and underwent percutaneous coronary intervention from 2005 to 2015 were included. Patients with a history of myocardial infarction, percutaneous coronary intervention, or coronary artery bypass graft surgery were included in the established CAD cohort. The primary end points were 12-month mortality and 12-month MACE. Of the 12,878 ACS patients included in our study, 3,542 (28%) patients had established CAD. Over the 10-year study period, the proportion of patients presenting with established CAD decreased (30.7% to 25.2%; p-for-overall-trend <0.001). Non-ST elevation myocardial infarction was the most prominent presentation in the established CAD cohort (45.1%) whereas ST-elevation myocardial infarction was the most prominent in the de novo CAD cohort (51%; p < 0.001). The patients in the established CAD cohort were older, had more co-morbidities and were more likely to present with high-risk features such as atrial fibrillation, left main disease, multivessel CAD and left ventricular dysfunction (all p < 0.001). Regarding revascularization in ST-elevation myocardial infarction presentations, symptom-to-door time was shorter, whereas door-to-balloon-time was longer in those with established CAD (p < 0.001). On multivariate analysis, established CAD was an independent risk factor for 12-month MACE (odds ratio 1.40, 95% confidence intervals 1.23 to 1.58, p < 0.001), but not for 12-month mortality (odds ratio 1.08, 95% confidence intervals 0.77 to 1.52, p = 0.66). In conclusion, patients with a history of myocardial infarction or previous revascularization have a higher rate of MACE at 12 months. Despite this they do not appear to suffer from higher mortality.
DOI: 10.1016/j.amjcard.2019.01.037
ORCID: 0000-0002-3706-4150
PubMed URL: 30797559
Type: Journal Article
Appears in Collections:Journal articles

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