233 After acute coronary syndrome, atheroma burden predicts cardiovascular prognosis of patients receiving optimized secondary prevention measures

Abstract

After an acute coronary syndrome (ACS), pharmacologic therapy and lifestyle intervention (optimal medical therapy, OMT) are efficient in reducing cardiovascular (CV) events. However, even if recommended secondary prevention goals are reached, a subset of patients still present CV events. To identify biological or cardiovascular markers predicting the residual risk of CV events in post-ACS patients receiving OMT. 990 patients benefited from an evaluation of risk factors and atherosclerosis lesions, and optimization of long-term treatment and education. Traditional CV risk factors and atheroma disease markers (intima-media thickness (IMT), carotid atheroma, Ankle Brachial Index (ABI) and number of coronary arteries with >50% stenosis) were evaluated 3 months after ACS. CV events were recorded at follow-up (CV death, ACS, stroke, heart failure, revascularization). At a median follow-up of 20 months, more than 80% of the patients reached recommended prevention goals. 116 total CV events were recorded. Diabetes was the only CV risk factor significantly associated with CV events in multivariate analysis (including age, sex, hypertension, LDL cholesterol, smoking, diabetes and hsCRP); HR 1,61 (1,09–2,39), p = 0,017. In multivariate analysis including CV risk factors and atheroma disease markers (peripheral vascular disease (PVD) defined as ABI<0,9, carotid plaque > 50%, IMT >0,7 mm, 3-vessel and/or left main coronary disease), only PVD remained significantly associated with CV events; HR 1,83 (1,02–3,31), p = 0,04. The number of vascular beds involved was associated with poorer prognosis: HR for 3 vascular-beds disease 3,85 (1,72–8,63) p = 0,001, given 1 vascular-bed disease as a reference group. In post-ACS patients with OMT, PVD and atheroma burden represent powerful prognostic markers of CV events, while diabetes remains the only independent marker of CV events among traditional CV risk factors.