Long-term predictors of major adverse cardiovascular events occurred in NSTE-ACS Algerian patients: Five-year follow-up

Abstract

Risk assessment of patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) is the primordial step of management. Identification and analysis of predictive factors of long-term major cardiovascular events in non-ST-elevation acute coronary syndromes in an Algerian population. Prospective study including all patients admitted to our cardiology department for NSTE-acute coronary syndrome between November 01, 2015 and October 31, 2016 having benefited from a systematic invasive attitude with an average follow-up spanning more than 5 years, antecedents, risk factors, clinical, electrical, biological, echocardiographic and angiographic elements are collected individually and with the calculation of different risk scores (Grace, TIMI, PURSUIT, FRISC, HEART scores …) and angiographic scores (Syntax score, Jeopardy score, Duke coronary index, Gensini score …), MACCE at five-year, as well as global and cardiovascular mortality are correlated with the different elements and scores in an univariate, multivariate analysis, survival Kaplan–Meier curve, curve of occurrence of MACCE and ROC curve. Of the 296 patients included, we were able to ensure long-term follow-up in 274 patients (22 patients lost to follow-up/non-consenting, 7.4%) the rate of MACCE at 5 years is 35.0%, and the mortality rates of cardiovascular and global origin at 5 years were 15.7% and 18.6% respectively. The prognostic factors correlated with cardiovascular mortality at 5 years are age (per decade) OR at 1.56 (CI: 1.03–2.36, P < 0.036), renal function OR at 2.73 (CI: 1.24–6.0, P < 0.013), BNP > 300 pg/mL OR at 4.39 (CI: 1.93–9.98, P < 10−3), LVEF OR at 2.57 (CI: 1.38–4.80, P < 0.003) and carotid IMT OR at 4.72 (CI: 1.86–12.0, P < 0.001). The prognostic factors correlated with the occurrence of major cardiovascular events at 5 years are age (per decade) OR at 1.28 (CI: 1.01–1.63, P < 0.048), diabetes OR at 1.76 (CI: 1.02–3.04, P < 0.041), a Q wave of necrosis on the ECG (sequel) OR at 3.39 (CI: 1.61–7.12, P < 0.001), renal function OR at 2.57 (CI: 1.38–4.80, P < 0.013) and positive troponins OR at 1.91 (CI: 1.07–3.41, P < 0.029) (Fig. 1). This real-life study allowed us to identify relevant prognostic markers that allow us to guide therapeutic attitude: identified patients’ candidates for prolonged DAPT and made orientation for both primary and secondary prevention.