P3400Definition of extremely high cardiovascular risk in patients after acute myocardial infarction - Data from the TERCET Registry

Abstract

Abstract Background The latest guidelines from the American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE) introduced a new “ultra-high risk” category of patients, for whom a low-density lipoprotein cholesterol (LDL-C) level <55 mg/dL (1.4 mmol/L) is advised. Purpose Therefore we aimed at identification of the risk factors in patients after acute myocardial infarction (MI), which increased the risk most, and might help to define the group of individuals at extremely high cardiovascular (CV) risk. Methods We analyzed consecutive patients included in the TERCET Registry admitted to the Polish tertiary cardiovascular centre due to MI between 2006 and 2018. According to the guidelines of the European Society of Cardiology (ESC), all patients included in the analysis are considered as of very high CV risk. All patients included in the registry underwent coronary angiography during the hospital stay. On the basis of multivariate analysis, we determined the subgroup of patients with the most unfavourable 12-month outcome (all-cause mortality). Results Finally, 4,562 patients admitted due to STEMI or NSTEMI and discharged from our centre were included in the analysis. According to the results of multivariate analysis performed with stepwise backward regression model, the following risk factors in patients after MI: LVEF<35% (odds ratio [OR]=3.83, 95% confidence interval [CI]: 3.14–4.67), age>75 years (OR=1.91, 95% CI: 1.55–2.35), lack of PCI of culprit vessel (OR=1.66, 95% CI: 1.26–2.20), multivessel CAD (OR=1.60, 95% CI: 1.30–1.99), atrial fibrillation (OR=1.53, 95% CI: 1.21–1.94), diabetes mellitus (OR=1.34, 95% CI: 1.11–1.64), increased LDL-C level (OR=1.09 per 1 mmol/L, 95% CI: 1.01–1.19) and increased creatinine level (OR=1.04 per 10 μmol/L, 95% CI: 1.04–1.05), might help to define the group of patients at extremely-high cardiovascular risk (all p<0.05). The aggregate summary of risk factors associated with extremely high risk is presented in the attached Figure. Next, the effect of the combination of the aforementioned risk factors will be investigated, and SCORE applied for patients in secondary prevention after MI will be prepared. Multivariate analysis results Conclusions To our knowledge, the presented study is the first such an analysis conducted on the population of patients after myocardial infarction gathered in the registry of secondary cardiovascular prevention. In patients after MI, potential risk factors were identified that might help to define the group of patients at ultra-high/extremely-high risk, what might contribute to significantly higher 12-month mortality. Acknowledgement/Funding None