Clinical Profile and Outcome of Post-revascularization Patients Presenting with Acute Coronary Syndrome: A Retrospective Study

Abstract

BACKGROUND: Studies on previously revascularized patients presenting with acute coronary syndrome (ACS) are lacking, especially among Asian patients. This study aimed to provide data regarding the risk factors and clinical profile of post-revascularization patients who present with ACS in a local medical institution. METHODOLOGY: This was a retrospective cohort study conducted at the Philippine Heart Center from January 2009 to December 2011. The study included all adult patients with a previous history of revascularization and admitted for ACS. Data collection was achieved through chart review. Data collected included demographic variables, coronary risk factors, medication history, and invasive revascularization procedure. Measured outcomes included mortality; hospitalization due to cardiovascular causes; occurrence of symptomatic heart failure; stroke; and arrhythmias. RESULTS: Seventy nine patients were included. The mean age was 66 years ± 13.87. The most common CV risk factors aside from gender and a previous history of ACS were hypertension (78.5%) and smoking (60.8%) as predominant risk factors. The most common clinical presentation of ACS was non-ST elevation MI (NSTEMI) (53.0%), followed by ST elevation MI (STEMI) (18.7%) and unstable angina (29.1%). Majority did not receive revascularization for the current admission (79.8%); 15.2% received PCI; 2.5% underwent CABG; and 2.5% underwent thrombolysis. Twenty four patients (30.4%) experienced a major adverse cerebrocardiovascular event (MACCE), which included death, hospitalization for HF, arrhythmia, and stroke. CV mortality was 15%. The only statistically significant independent variable predictive of MACCE was age (p=0.032). All patients who underwent dialysis or intra-aortic balloon pump (IABP) insertion developed a negative outcome.