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Multicenter Study
. 2018 Apr 12;13(4):e0195174.
doi: 10.1371/journal.pone.0195174. eCollection 2018.

Prognosis of cardiovascular and non-cardiovascular multimorbidity after acute coronary syndrome

Silvia Canivell  1 , Olivier Muller  2 , Baris Gencer  3 , Dik Heg  4 , Roland Klingenberg  5 , Lorenz Räber  6 , David Carballo  3 , Christian Matter  5 , Thomas Lüscher  5 , Stephan Windecker  6 , François Mach  3 , Nicolas Rodondi  7   8 , David Nanchen  1
Affiliations
Multicenter Study

Prognosis of cardiovascular and non-cardiovascular multimorbidity after acute coronary syndrome

Silvia Canivell et al. PLoS One. .

Abstract

Objective: To examine the prognosis of patients with cardiovascular and non-cardiovascular multimorbidity after acute coronary syndrome compared to patients without prior multimorbidity.

Methods: This multicenter prospective cohort study in Switzerland included 5,635 patients hospitalized with acute coronary syndrome between 2009 and 2014, with a one-year follow-up period. We defined cardiovascular and non-cardiovascular multimorbidity as having at least two prior comorbidities before the index hospitalization. Multivariable adjusted Cox proportional models were built to assess the one-year risk of recurrent cardiovascular events, defined as cardiovascular mortality and non-fatal myocardial infarction or stroke. The final model was adjusted for age, gender, body mass index, tobacco consumption, education, and family history of cardiovascular disease, prescription of high-dose statinsat discharge and use of cardiac rehabilitation after discharge.

Results: Overall, 3,664 patients (65%) had no multimorbidity, 1,839 (33%) had cardiovascular multimorbidity, 62 (1%) had non-cardiovascular multimorbidity, and 70 (1%) had both cardiovascular and non-cardiovascular multimorbidity. The multivariate risk of recurrent cardiovascular events was increased among patients with cardiovascular multimorbidity (hazard ratio (HR) 2.05, 95% CI: 1.54-2.73, p<0.001) and patients with non-cardiovascular multimorbidity (HR 2.57, 95% CI: 1.04-6.35, p = 0.04) compared to patients without multimorbidity. Patients with cardiovascular and non-cardiovascular multimorbidity had the highest risk of recurrence with a HR of 5.19, 95% CI: 2.79-9.64, p<0.001, compared to patients without multimorbidity.

Conclusions: Multimorbidity increased by two-fold the risk of cardiovascular events over the year after an acute coronary syndrome. The magnitude of this increased risk was similar for patients with cardiovascular or non-cardiovascular multimorbidity.

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Conflict of interest statement

Competing Interests: Prof Lüscher reports receiving research grants to the institution from Abbott, Biosensors, Biotronik, Boston Scientific, Daichi Sankyo, Eli Lilly and Medtronic, and consultant payments from AstraZeneca, Boehringer Ingelheim, Bayer, Merck, and Pfizer, MSD, Roche and Servier. Prof Matter reports receiving grants from MSD, Eli Lilly, AstraZeneca, Roche and Bayer; expert testimony from MSD; payment for lectures from MSD, AstraZeneca, and Roche; and having patents from Mabimmune, CH. Prof Windecker reports receiving research contracts to the institution from Abbott, Biotronik, Boston Scientific, Biosensors, Cordis, Medtronic, St. Jude Medical. Prof Mach has received honoraria for advisory boards and conferences on dyslipidaemia from Amgen, AstraZeneca, BMS, Eli Lilly, MSD, Sanofi, and Pfizer. All other authors report no conflicts of interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Cardiovascular events rates after acute coronary syndrome, by presence of cardiovascular and non-cardiovascular multimorbidity.
Fig 2
Fig 2. Coronary events rates after acute coronary syndrome, by presence of cardiovascular and non-cardiovascular multimorbidity.
See this image and copyright information in PMC

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