Prospective 5-year follow-up of patients with acute coronary syndrome and percutaneous coronary intervention

Abstract

Background. The study of predictors that negatively affect the long-term prognosis of patients with an increased risk of coronary syndrome can improve the effectiveness of measures for the secondary prevention of cardiovas­cular events.

Aim. To determine the factors that have a negative impact on 5-year survival in patients with acute coronary syndrome and percutaneous coronary intervention.

Material and methods. 135 patients with acute coronary syndrome enrolled in the “Register of percutaneous coronary interventions” in 2012–2013 at the Tyumen Cardiology Center, a branch of the Tomsk Research Institute of Cardiology of the Russian Academy of Sciences, were included in the study. After 12 and 60 months, the clinical status of patients and ongoing drug therapy were evaluated, and an examination including echocardiography with an ultrasound scanner, daily monitoring of the electrocardiogram and standard blood pressure measuring was performed. Laboratory studies included general and biochemical blood tests. To calculate the factors associated with poor prognosis, a Cox proportional hazards regression model with stepwise inclusion was used. Survival was assessed by the Kaplan–Meier method using the Log-rank test (logarithmic test).

Results. After 1 year, only three-quarters of patients continued the recommended drug therapy, a similar trend continued after 5 years of follow-up. The number of patients without any antiplatelet therapy increased from 19.9% after 12 months to 29.7% after 60 months. Overall survival after 1 year was 97.1%, after 5 years — 86.7%. The risk of death increased in the presence of chronic kidney disease (risk ratio 15.1; 95% confidence interval 4.30–52.93; p=0.001); type 2 diabetes mellitus (risk ratio 3.67; 95% confidence interval 1.18–11.43; p=0.025), history of stroke (risk ratio 9.07; 95% confidence interval 1.85–44.60; p=0.007), in patients with a heart rate >80 beats per minute [risk ratio 4.3; (95% confidence interval 1.51–12.26; p=0.006) and at pulse pressure ≥60 mm Hg (risk ratio 4.68; 95% confidence interval 1.60–13.72; p=0.005)].

Conclusion. The predictors that influenced the 5-year survival of patients after acute coronary syndrome and percutaneous coronary intervention were chronic kidney disease, diabetes mellitus, a history of stroke, high pulse pressure, and increased heart rate of more than 80 beats per minute.

Keywords

acute coronary syndrome register / percutaneous coronary intervention / predictors of 5-year survival

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