Abstract
Background: Cardiovascular (CV) disease is the leading cause of mortality in the US and worldwide; thus, it is important to understand the disease sequelae and prognostic predictors to help improve patient outcomes and reduce healthcare costs. Methods: Patients with an ICD-9 code for acute myocardial infarction (MI) or unstable angina (UA) during acute coronary syndrome (ACS) hospitalization were identified from the HealthCore Integrated Research Database (HIRD SM ) between Jan 2006 and Sep 2011. A multivariable Cox proportional hazards model was used to evaluate the effect of risk factors on time to first subsequent CV event (defined as stroke, MI or CHD-related mortality), adjusting for baseline demographic characteristics, comorbidities, treatment utilization and index ACS characteristics. Results: Of 140,903 ACS patients identified, mean age was 66.8 years, 58.6% were male, and mean follow-up was 1.9 years. Baseline comorbidities include 41.9% with type 1 or 2 diabetes mellitus (DM), 60.4% hypertension (HTN), 10.7% renal dysfunction and 3.3% prior CABG/PCI. During the index ACS hospitalization, 42.7% had UA, 40.3% CABG and/or PCI and 3.6% of patients died. A total of 22.0% of patients had a recurrent CV event following index ACS, with an increased adjusted hazard of a recurrent event if the patient was older (hazard ratio=1.48 in > 65 vs <65 years), had a history of heart failure (HR=1.41), renal dysfunction (HR=1.36), HTN (HR= 1.14) or DM (HR=1.10), all P < 0.001. Additionally, patients had a decreased adjusted hazard of a recurrent CV event with pre-admission single or fixed-dose combination statin use (HR=0.96 and 0.87, respectively) or a CABG prior to admission (HR=0.89), all P <0.001. Conclusion: Following an ACS event, patients with pre-admission statin use or a prior CABG had decreased risk, while older patients or those with baseline comorbidities had increased risk of an adverse CV event occurring sooner. Ultimately, identifying high-risk ACS subgroups may facilitate tailored and more aggressive treatment to improve outcomes.
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