Abstract P477: Clinical Outcomes In Individuals With And Without Heart Failure Presenting With Acute Coronary Syndromes

Abstract

Objective: To determine the risk for major adverse cardiovascular events (MACE) following acute coronary syndrome (ACS) in patients with and without heart failure (HF) and whether this risk varies by race and comorbidity. Methods: We studied adults with and without HF who underwent percutaneous coronary intervention (PCI) for the treatment of ACS in the Pharmacogenomic Resource to improve Medication Effectiveness Genotype Guided Antiplatelet Therapy study. ACS was defined by the presence of ≥2 of the following: ischemic symptoms, acutely elevated cardiac troponin, or ischemic electrocardiographic changes. HF was defined prior to PCI as a known history of HF, left ventricular ejection fraction <50%, or brain natriuretic peptide level >400 pg/mL. Demographic and clinical characteristics were collected prior to PCI. Race was self-reported. Participants were followed for up to 1 year for MACE. We constructed Cox proportional hazard models, adjusted for demographic and clinical characteristics, separately in those with and without HF to identify independent predictors of MACE. Results: Since 2014, 1,230 individuals have undergone PCI for ACS. Those with HF (n=419) were older and had more comorbidities than those without HF (n=811). The incidence of MACE per 100 person years was 40.4 in those with HF and 22.2 in those without HF (p<0.001). African American race was associated with increased risk for MACE following ACS in those without but not with a history of HF. Other clinical factors associated with MACE following ACS were older age and end stage renal disease in those with HF and diabetes, end stage renal disease, and peripheral arterial disease in those without HF (Table). Conclusions: Individuals with HF are at increased risk of MACE following ACS irrespective of race. However, in those without HF, African Americans have a higher risk of MACE following ACS relative to their white counterparts. Individuals with end stage renal disease are at high risk of MACE following ACS regardless of HF status.