0520: Determinants of 3-year mortality after an acute coronary syndrome – the French population MONICA registry

Abstract

Determinants of short-term mortality after acute coronary syndrome (ACS) are relatively well known. However, those for middle-term mortality aren’t clearly established. The aim of our study was to describe 28-day mortality in patients hospitalized for ACS in comparison with the middle-term mortality. Methods this study was based on data from 6812 people aged 35-74 years hospitalized for a first or a recurrent ACS, registered in the Strasbourg and Toulouse MONICA registry between 2009 and 2011. Three categories of ACS were defined: (ST+), ACS with ST elevation at ECG; (ST-Enz+), ACS with no ST elevation plus significant cardiac enzyme elevation; (ST-Enz-), ACS with no ST elevation and no enzyme elevation. The mean of follow up was 3.3±1.1 years with a maximum of 5 years. In all there were 2441 (35.8%) ACS with (ST+), 1548 (22.7%) ACS with (ST-Enz+) and 2823 (41.4%) patients with (ST-Enz-). The 28-day mortality rate (number of deaths =760) was 11.2% [8.9-13.4] and the middle-term mortality (number of deaths =576) rate was 9.5% [7.1-11.9]. The risk of death at 28-days was (OR [95% CI]) 0.67 [0.51-0.88] for (ST-Enz+) and 2.74 [2.29-3.28] for (STEnz-) in comparison with (ST+). After multivariate adjustments; region, gender, age, history of IHD and complications at hospital admission odds ratios remained significant; 0.70 [0.5-0.88] for (ST-Enz+) and 3.56 [2.8-4.54] for (ST-Enz-) respectively. In patients who survived after 28 days (n=6052), the middle-term risk of death was after multivariate adjustments (HR [95% CI]) 1.42 [1.15-1.77] in (ST-Enz+) in comparison to (ST+) and 1.07 [0.86-1.32] in (ST-Enz-). For STEMI patients risk of death was higher at 28 day and lower when middle-term mortality was considered. These patterns were inverse for NSTEMI (ST+Enz-) patients. In the early years following ACS, mortality rate was around 2.9% each year.