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. 2025 Jun 18;12(6):234.
doi: 10.3390/jcdd12060234.

Predictors of Five-Year Outcomes in Patients with Acute Coronary Syndromes

Luca Di Vito  1 , Giancarla Scalone  1 , Federico Di Giusto  1 , Filippo Bruscoli  1 , Simona Silenzi  1 , Adelina Selimi  2 , Arianna Massari  2 , Domenico Delfino  1 , Federico Guerra  2 , Pierfrancesco Grossi  1
Affiliations

Predictors of Five-Year Outcomes in Patients with Acute Coronary Syndromes

Luca Di Vito et al. J Cardiovasc Dev Dis. .

Abstract

Background: Residual risk after acute coronary syndromes (ACSs) continues to affect prognosis. We investigated the impact of female sex, non-ST-segment-elevation myocardial infarction (NSTEMI), diabetes mellitus (DM), and chronic kidney disease (CKD) on coronary atherosclerosis extent, culprit stenosis location, and bio-humoral data. The rate of both major adverse cardiovascular events (MACE) and non-fatal recurrent coronary events (RCE) was additionally evaluated.

Methods: We enrolled 1404 ACS patients and followed them for up to 5 years. Coronary culprit and non-culprit stenoses were analyzed using angiography. Biohumoral data was assessed at admission and at 1 month and 12 months after discharge. Patients were compared based on sex, NSTEMI, DM, and CKD presence.

Results: NSTEMI patients had a higher number of total coronary stenoses (3.5 vs. 3.3, p = 0.013) and non-culprit stenoses (2.3 vs. 1.6, p = 0.0001). Non-culprit percent stenosis was significantly greater in NSTEMI as compared to STEMI patients (57.9% vs. 47.1%, p = 0.0001). DM patients had a higher frequency of bifurcation lesions (41% vs. 25%, p = 0.0001). CKD patients showed a higher prevalence of left main disease (3.4% vs. 1.5%, p = 0.038). Female patients had higher LDL-cholesterol values at 1 month and 12 months. NSTEMI, DM, and creatinine level were independent predictors of MACE. NSTEMI patients had an increased risk of non-fatal RCE.

Conclusions: NSTEMI, DM, and creatinine levels at admission were independent predictors of MACE in the first 5 years after an ACS.

Keywords: acute coronary syndrome; chronic kidney disease; diabetes mellitus; residual risk; sex-related differences.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Mean LDL-cholesterol values at hospital admission, 1-month, and 12-month follow-up according to the four residual risk determinants. Panel (A): Male vs. Female (main effect p = 0.044). Panel (B): STEMI vs. NSTEMI (main effect p = 0.207). Panel (C): non-DM vs. DM (main effect p = 0.076). Panel (D): Non-CKD vs. CKD (main effect p = 0.128). Time effect for all groups: p < 0.0001 (Wilk’s Lamda = 0.466). Mixed between-within ANOVA was used.
Figure 2
Figure 2
Kaplan–Meier curves for MACEs based on residual risk determinants. Panel (A): Female vs. Male (log-rank p = 0.0001). Panel (B): NSTEMI vs. STEMI (log-rank p = 0.0001). Panel (C): DM vs. Non-DM (log-rank p = 0.006). Panel (D): CKD vs. non-CKD (log-rank p = 0.0001). Comparisons were performed using the log-rank test.
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