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Comparative Study
. 2022 Feb 14;17(2):e0263589.
doi: 10.1371/journal.pone.0263589. eCollection 2022.

Comparison of clinical profiles and care for patients with incident versus recurrent acute coronary syndromes in France: Data from the MONICA registries

Suzanne Machta  1 , Victoria Gauthier  1 , Jean Ferrières  2   3   4 , Michèle Montaye  2 , Samantha Huo Yung Kai  3   4   5 , Stefy Gbokou  6 , Katia Biasch  6 , Marie Moitry  6   7 , Philippe Amouyel  1 , Jean Dallongeville  1 , Aline Meirhaeghe  1
Affiliations
Comparative Study

Comparison of clinical profiles and care for patients with incident versus recurrent acute coronary syndromes in France: Data from the MONICA registries

Suzanne Machta et al. PLoS One. .

Abstract

Background: Recurrence is common after an acute coronary syndrome (ACS). In order to better assess the prognosis for patients with ACS, we compared clinical profiles, treatments, and case fatality rates for incident vs. recurrent ACS.

Methods: We enrolled 1,459 men and women (age: 35-74) living in three geographical areas covered by French MONICA registries and who had been admitted to hospital for an ACS in 2015/2016. We recorded and compared the clinical characteristics and medical care for patients with an incident vs. a recurrent ACS.

Results: Overall, 431 (30%) had a recurrent ACS. Relative to patients with an incident ACS, patients with recurrence were older (p<0.0001), had a greater frequency of NSTEMI or UA (p<0.0001), were less likely to show typical symptoms (p = 0.045), were more likely to have an altered LVEF (p<0.0001) and co-morbidities. Angioplasty was less frequently performed among patients with recurrent than incident NSTEMI (p<0.05). There were no intergroup differences in the prescription of the recommended secondary prevention measures upon hospital discharge, except for functional rehabilitation more frequently prescribed among incident patients (p<0.0001). Although the crude 1-year mortality rate was higher for recurrent cases (14%) than for incident cases (8%) (p<0.05), this difference was no longer significant after adjustment for age, sex, region, diagnosis category and LVEF.

Conclusion: Compared with incident patients, recurrent cases were more likely to have co-morbidities and to have suboptimal treatments prior to hospital stay, reinforcing the need for secondary prevention.

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Conflict of interest statement

NO authors have competing interests.

Figures

Fig 1
Fig 1. Drug treatments before hospital admission in patients with an incident or recurrent acute coronary syndrome.
*p<0.001, **p<0.0001, after adjustment for sex and age. PAI: Platelet aggregation inhibitor; BB: Beta-blocker; ACEI: Angiotensin-converting-enzyme inhibitor; ARBs: Angiotensin receptor blockers; S: Statin.
Fig 2
Fig 2. Drug treatments upon hospital discharge in patients with an incident or recurrent acute coronary syndrome.
*p<0.05, **p<0.0001, after adjustment for sex and age. PAI: Platelet aggregation inhibitor; BB: Beta-blocker; ACEI: Angiotensin-converting-enzyme inhibitor; ARBs: Angiotensin receptor blockers; S: Statin.
Fig 3
Fig 3. 28-day and 1-year survival curves.
A. 28-day survival curves. B. 1-year survival curves.
See this image and copyright information in PMC

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