Abstract
Aims To evaluate risk factors for major adverse cardiac event (MACE) after the first acute coronary syndrome (ACS) and to examine the prevalence of risk factors in post-ACS patients. Methods We used Finnish population-based myocardial infarction register, FINAMI, data from years 1993–2011 to identify survivors of first ACS (n = 12686), who were then followed up for recurrent events and all-cause mortality for three years. Finnish FINRISK risk factor surveys were used to determine the prevalence of risk factors (smoking, hyperlipidaemia, diabetes and blood pressure) in post-ACS patients (n = 199). Results Of the first ACS survivors, 48.4% had MACE within three years of their primary event, 17.0% were fatal. Diabetes (p = 4.4 × 10−7), heart failure (HF) during the first ACS attack hospitalization (p = 6.8 × 10−15), higher Charlson index (p = 1.56 × 10−19) and older age (p = .026) were associated with elevated risk for MACE in the three-year follow-up, and revascularization (p = .0036) was associated with reduced risk. Risk factor analyses showed that 23% of ACS survivors continued smoking and cholesterol levels were still high (>5mmol/l) in 24% although 86% of the patients were taking lipid lowering medication. Conclusion Diabetes, higher Charlson index and HF are the most important risk factors of MACE after the first ACS. Cardiovascular risk factor levels were still high among survivors of first ACS.
Highlights
Cardiovascular diseases (CVD) are the leading cause of death in many countries
Previous studies have focussed on major adverse cardiac event (MACE) after either a non-ST-elevation myocardial infarction (NSTEMI) or STelevation myocardial cinfarction (STEMI) and current studies rarely separate between MACE after the first event or recurrent event [5,7,11,12]
We examined the prevalence of risk factors among a populationbased sample of post-acute coronary syndrome (ACS) patients from the FINRISK risk factor survey-populations to gain understanding of the current treatment and control levels of these risk factors
Summary
Cardiovascular diseases (CVD) are the leading cause of death in many countries. In 2017 17.8 million people died because of a CVD event [1]. Many studies have been published on risk factors for coronary heart disease (CHD) which is the leading component of CVD [1,2]. Left ventricular systolic dysfunction, severity of CHD and comorbidities are associated with high risk of an adverse outcome [3,5,7]. Different risk indicators for major adverse cardiac event (MACE) after an acute coronary syndrome (ACS), such as angiographic outcome and left ventricular function, have been previously observed [6,7]. The short-term risk of MACE after ACS is well known [5,8,9]. The long-term risk factors for MACE after an ACS have been rarely examined [5,8,10,11]. Previous studies have focussed on MACE after either a non-ST-elevation myocardial infarction (NSTEMI) or STelevation myocardial cinfarction (STEMI) and current studies rarely separate between MACE after the first event or recurrent event [5,7,11,12]
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