Abstract
Background: While clinical trials often use the endpoint of major adverse cardiovascular events (MACE) that include unstable angina (UA) and coronary revascularization outcomes, to power the studies, the relationship of these components to mortality is not known. Methods: Using a 24-center observational cohort study of 3283 AMI patients, we identified those with an unplanned coronary revascularization or unstable angina (UA) admission and calculated the subsequent rates of 1-year cardiovascular hospitalizations and 2-year mortality. Staged revascularizations electively performed 30 demographic, clinical, and health status data and achieved good balance between the cohorts (standardized difference <10% for all). Proportional hazards models of subsequent outcomes were compared for those who did and did not have an event after their AMI. Results: A total of 144 (4.39%) patients underwent unplanned revascularization and 140 (4.26%) were readmitted for UA after their AMI, of whom 9.6% and 30.2% died or were readmitted after an unplanned revascularization and 5.2% and 36.8% had these events after an UA admission. After propensity adjustment, the risk of mortality (HR=1.84) and cardiovascular rehospitalization (HR=5.13) were elevated among those who underwent revascularization vs. those who did not. The adjusted risk of 2-year mortality was not elevated after an UA event (HR=0.95) but the risk of cardiovascular rehospitalization was (HR=7.26; Table ). Conclusions: Patients undergoing coronary revascularization or those readmitted for UA following AMI have greater subsequent risks for cardiovascular rehospitalizations as compared with those who do not get readmitted for these reasons. Subsequent survival is also worse in those who underwent coronary revascularization following AMI. From a prognostic standpoint, the inclusion of revascularizations and UA admissions as a component of a MACE outcome in clinical trials may be reasonable from a prognostic standpoint.
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call