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. 2020 Sep 15:315:1-8.
doi: 10.1016/j.ijcard.2020.05.022. Epub 2020 May 7.

Two-year outcomes post-discharge in Asian patients with acute coronary syndrome: Findings from the EPICOR Asia study

Yong Huo  1 , Stephen W-L Lee  2 , Jitendra P S Sawhney  3 , Hyo-Soo Kim  4 , Rungroj Krittayaphong  5 , Stuart J Pocock  6 , Vo T Nhan  7 , Ángeles Alonso-Garcia  8 , Chee Tang Chin  9 , Jie Jiang  10 , Stephen Jan  11 , Ana M Vega  12 , Nobuya Hayashi  13 , Tiong Kiam Ong  14
Affiliations

Two-year outcomes post-discharge in Asian patients with acute coronary syndrome: Findings from the EPICOR Asia study

Yong Huo et al. Int J Cardiol. .

Abstract

Aims: Approximately half of cases of cardiovascular disease (CVD) worldwide occur in Asia, with acute coronary syndrome (ACS) a leading cause of mortality. Long-term ACS-related outcomes data in Asia are limited. This analysis examined 2-year ACS-related outcomes in patients enrolled in the EPICOR Asia study, and the association between patient characteristics and management on outcomes.

Methods: EPICOR Asia is a multinational, prospective, primary data collection study of real-world management of Asian patients with ACS. Overall, 12,922 eligible adults (hospitalized for ACS within 48 h of symptom onset and who survived to discharge) were enrolled from 219 centers in eight Asian countries. Patients were followed up post-discharge for 2 years and clinical outcomes recorded.

Results: Patients were of mean age 60 years and 76% were male. Diagnoses were STEMI (51.2%), NSTEMI (19.9%), and UA (28.9%). During follow-up, 5.2% of patients died; NSTEMI patients had the highest risk profile. Mortality rate (adjusted HR [95% CI]) was similar in NSTEMI (0.97 [0.81-1.17]) and lower in UA (0.52 [0.33-0.82]) vs STEMI. Similar trends (adjusted) were seen for the composite endpoint of death, myocardial infarction, or ischemic stroke, and bleeding rates did not differ significantly. For all three diagnoses, patients who were medically managed had a markedly elevated risk of both death and the composite endpoint.

Conclusions: During 2-year follow-up, adjusted risks of mortality, the composite endpoint, and bleeding rates were similar in NSTEMI and STEMI patients. Outcomes risk was better for invasive management. Long-term management strategies in Asia need to be optimized.

Keywords: Acute coronary care; Acute coronary syndrome; Antithrombotic management patterns; Asia; Observational; Post-discharge mortality.

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Conflict of interest statement

Declaration of Competing Interest Yong Huo, Stephen W-L Lee, Jitendra PS Sawhney, Hyo-Soo Kim, Ángeles Alonso-Garcia, Jie Jiang, and Stephen Jan have nothing to disclose. Rungroj Krittayaphong has been a consultant or advisory board member for AstraZeneca and Boehringer Ingelheim. Stuart J Pocock receives research funds from AstraZeneca. Vo T Nhan has received research grants from AstraZeneca, Servier, Sanofi, and Boston Scientific, and has been a consultant or advisory board member for AstraZeneca, Pfizer, Sanofi, Boehringer Ingelheim, Servier, MSD, Abbott, Bayer, Novartis, Merck Serono, Biosensor, Biotronic, Boston Scientific, Terumo, and Medtronic. Chee Tang Chin has received research support from Eli Lilly and honoraria from Medtronic, and has been a consultant or advisory board member for AstraZeneca. Ana M Vega was a former employee of AstraZeneca and Nobuya Hayashi is a current employee of AstraZeneca. Tiong Kiam Ong has acted as a consultant or advisory board member for Sanofi-Aventis, Abbott Vascular, Boston Scientific, Boehringer Ingelheim, Novartis, and AstraZeneca.

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