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Observational Study
. 2019 Jan;42(1):111-119.
doi: 10.1002/clc.23116. Epub 2018 Dec 7.

Predictors of all-cause mortality and ischemic events within and beyond 1 year after an acute coronary syndrome: Results from the EPICOR registry

Xavier Rossello  1   2   3 , Héctor Bueno  1   4 , Stuart J Pocock  2 , Frans Van de Werf  5 , Nicolas Danchin  6 , Lieven Annemans  7 , Jesús Medina  8 , Uwe Zeymer  9
Affiliations
Observational Study

Predictors of all-cause mortality and ischemic events within and beyond 1 year after an acute coronary syndrome: Results from the EPICOR registry

Xavier Rossello et al. Clin Cardiol. 2019 Jan.

Abstract

Background: Patients discharged after an acute coronary syndrome (ACS) have substantial risk of recurrent ischemic events or dying.

Hypothesis: A difference may exist in risk predictors for all-cause mortality and ischemic events between year 1 and 2 of follow-up post-ACS.

Methods: EPICOR (NCT01171404) was a prospective, international, real-world cohort study of consecutive patients hospitalized for ACS within 24 hours of symptom onset and surviving to discharge. Total of 10 568 patients were enrolled (555 hospitals; 20 countries) and followed-up for 2 years. From these, 4943 were admitted with ST-elevation myocardial infarction (STEMI) and 5625 with non-ST-elevation ACS (NSTE-ACS). Potential baseline predictors of major adverse cardiac and cerebrovascular events (MACCE; death, non-fatal myocardial infarction [MI], non-fatal stroke) were evaluated in year 1 and 2 post-discharge.

Results: MACCE incidence per 100 person-years at risk within and after 1 year was 5.3 vs 3.6, primarily death (4.1 vs 2.3), with no significant differences for MI or stroke. Older age, lack of coronary revascularization, raised creatinine, low hemoglobin, previous cardiac disease, previous chronic obstructive pulmonary disease, raised glucose, male sex, and geographic region were risk factors for MACCE in both year 1 and 2. By contrast, low ejection fraction, poorer quality of life, low body mass index (BMI) <20 kg/m2 , in-hospital cardiac complications, and Killip class lost predictive power after 1 year.

Conclusion: We observed continuous MACCE risk during 2 years of follow-up after discharge for ACS, with greater mortality within the first year. Specific predictors at discharge for events after 1 year could not be identified.

Keywords: acute coronary syndrome; hospital discharge; mortality; prognostic model; risk predictor.

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Conflict of interest statement

Xavier Rossello has nothing to disclose. Stuart J. Pocock has received research and statistical consulting honoraria from AstraZeneca. Héctor Bueno has received advisory/consulting fees from Abbott, AstraZeneca, Bayer, Bristol‐Myers Squibb, Daiichi‐Sankyo, Eli Lilly, Novartis, Pfizer, Sanofi, and Servier, and grants from AstraZeneca. Frans van de Werf has received consulting fees and research grants from Boehringer Ingelheim and Merck, and consulting fees from Roche, Sanofi‐Aventis, AstraZeneca, and The Medicines Company. Nicolas Danchin has received fees for lectures or consulting from Amgen, AstraZeneca, Bayer, Bristol‐Myers Squibb, Boehringer Ingelheim, Daiichi‐Sankyo, Eli‐Lilly, MSD, Novo‐Nordisk, Pfizer, Sanofi, and Servier, and research grants from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Daiichi‐Sankyo, Eli‐Lilly, Merck, Pfizer, and Sanofi. Lieven Annemans received honoraria from AstraZeneca, Bayer, and BMS. Jesús Medina is an employee of AstraZeneca. Uwe Zeymer has received honoraria from AstraZeneca, Bayer, BMS, Daiichi Sankyo, Eli Lilly, Pfizer, Novartis, Medicines Company, Sanofi, and Amgen.

Figures

Figure 1
Figure 1
Patient flowchart. Abbreviations: ACS, acute coronary syndrome; MACCE, major adverse cardiac and cerebrovascular events
Figure 2
Figure 2
Kaplan‐Meier estimate of the risk of major adverse cardiac and cerebrovascular events (MACCE) at (A) year 1 of follow‐up after discharge, (B) year 2 of follow‐up (among year 1 MACCE‐free patients), and (C) incidence rate by event type. EPICOR had a total duration of 24 months, with the last interview conducted within ±2 weeks. Patients who completed study follow‐up were censored starting at 23.5 months. Time at risk (100 person‐years): year 1, 9748.4; year 2, 8348.7. Patients with non‐fatal event in year 1 were excluded from follow‐up in year 2. Year‐1 follow‐up, 10 568 patients at risk at start; year‐2 follow‐up, 9209 patients at risk at start. aMACCE, defined as death, non‐fatal MI and non‐fatal stroke. bPer 100 person‐years at risk. cYear 1 follow‐up as reference group. Abbreviations: CI, confidence interval; EPICOR, long‐term follow‐up of antithrombotic management patterns In acute CORonary syndrome; MACCE, major adverse cardiac and cerebrovascular events; MI, myocardial infarction
Figure 3
Figure 3
Kaplan‐Meier estimates of the risk for major adverse cardiac and cerebrovascular events (MACCE), and MACCE incidence rates according to the occurrence of revascularization (percutaneous coronary intervention [PCI], coronary artery bypass graft [CABG] or thrombolysis), in non‐ST‐segment elevation acute coronary syndrome (NSTE‐ACS) (upper panel) and ST‐elevation myocardial infarction (STEMI) patients (lower panel). Log‐rank estimates. Abbreviations: ACS, acute coronary syndrome; CI, confidence interval
See this image and copyright information in PMC

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