P4590Temporal trends of the characteristics, management, and clinical outcomes of patients with acute coronary syndrome and multi-vessel disease - the ACSIS registry

Abstract

Abstract Introduction Multi-vessel coronary artery disease (MVD) is common among patients with acute coronary syndrome (ACS) and is associated with worse outcomes compared with single-vessel disease. Multiple studies focused particularly on patients with ACS and MVD and their results were incorporated into guidelines' recommendations. Objectives To examine temporal trends in clinical characteristics, treatment and outcomes of patients presenting with ACS and MVD. Methods Time- dependent analysis of patients enrolled in the biennial ACS Israeli Surveys (ACSIS) between 2000 and 2016 according to three time periods: early (2004–2006; n=2,111), mid (2008–2010; n=2,049), and late (2013–2016; n=2,010). MVD was defined as >50% stenosis in ≥2 separate major coronary territories at the index ACS. Clinical outcomes were 30-day MACE (death, unstable angina, myocardial infarction, stroke, stent thrombosis, urgent revascularization) and 30-days and 1-year mortality. Results Overall 6,170/15,000 patients (41.1%) had MVD (age 64.5±12.1, males 80%). Patients admitted in the later periods were older with a higher prevalence of cardiovascular risk factors and their treatment (i.e. statins, and hypoglycemic drugs) prior to admission. The rate of CABG has decreased and of MV percutaneous coronary intervention and guideline recommended medical treatment has increased with time. At 30 days, the rates of mortality, MACE and re-infarction have decreased (Figure). A trend of reduction in 1-year mortality was observed with time, yet it did not reach statistical significance (early=9.3%, mid=7.8%, late=7.7%, P=0.13). A multivariate adjusted analysis demonstrated that the mid and late periods were associated with significantly reduced risk for 30-day MACE (OR=0.65 [0.54–0.77] and 0.54 [0.45–0.65], respectively). Figure 1. Temporal trends in 30-day outcomes of patients with ACS and MVD Conclusions During the last decade, the burden of cardiovascular risk factors among ACS patients with MVD has increased, more extensive invasive and medical treatments were provided and significant improvements in 30-day outcomes were observed. Acknowledgement/Funding None