First-time Acute Coronary Syndrome Research Articles

Prognosis and antithrombotic practice patterns in patients with recurrent and transient atrial fibrillation following acute coronary syndrome: A nationwide study

BackgroundFirst-time detected atrial fibrillation (AF) is associated with aggravated prognosis in patients admitted with acute coronary syndrome (ACS). Yet, among patients surviving beyond one year after ACS, it remains unclear how the recurrence of AF within the initial year after ACS affects the risk of stroke. MethodsWith Danish nationwide data from 2000 to 2021, we identified all patients with first-time ACS who were alive one year after discharge (index date). Patients were categorized into: i) no AF; ii) first-time detected AF during ACS admission without a recurrent hospital contact with AF (transient AF); and iii) first-time detected AF during ACS admission with a subsequent recurrent hospital contact with AF (recurrent AF). From index date, two-year rates of ischemic stroke were compared using multivariable adjusted Cox regression analysis. Treatment with antithrombotic therapy was assessed as filled prescriptions between 12 and 15 months following ACS discharge. ResultsWe included 139,137 patients surviving one year post ACS discharge: 132,944 (95.6%) without AF, 3920 (2.8%) with transient AF, and 2273 (1.6%) with recurrent AF. Compared to those without AF, the adjusted two-year hazard ratios of ischemic stroke were 1.45 (95% CI, 1.22–1.71) for patients with transient AF and 1.47 (95% CI: 1.17–1.85) for patients with recurrent AF. Prescription rates of oral anticoagulation increased over calendar time, reaching 68.3% and 78.7% for transient and recurrent AF, respectively, from 2019 to 2021. ConclusionIn patients surviving one year after ACS with first-time detected AF, recurrent and transient AF were associated with a similarly increased long-term rate of ischemic stroke.

Sex differences in outcomes after acute coronary syndrome vary with age: a New Zealand national study.

This study investigated age-specific sex differences in short- and long-term clinical outcomes following hospitalization for a first-time acute coronary syndrome (ACS) in New Zealand (NZ). Using linked national health datasets, people admitted to hospital for a first-time ACS between January 2010 and December 2016 were included. Analyses were stratified by sex and 10-year age groups. Logistic and Cox regression were used to assess in-hospital death and from discharge the primary outcome of time to first cardiovascular (CV) readmission or death and other secondary outcomes at 30 days and 2 years. Among 63 245 people (mean age 69 years, 40% women), women were older than men at the time of the ACS admission (mean age 73 vs. 66 years), with a higher comorbidity burden. Overall compared with men, women experienced higher rates of unadjusted in-hospital death (10% vs. 7%), 30-day (16% vs. 12%) and 2-year (44% vs. 34%) death, or CV readmission (all P < 0.001). Age group-specific analyses showed sex differences in outcomes varied with age, with younger women (<65 years) at higher risk than men and older women (≥85 years) at lower risk than men: unadjusted hazard ratio of 2-year death or CV readmission for women aged 18-44 years = 1.51 [95% confidence interval (CI) 1.21-1.84] and aged ≥85 years = 0.88 (95% CI 0.83-0.93). The increased risk for younger women was no longer significant after multivariable adjustment whereas the increased risk for older men remained. Men and women admitted with first-time ACS have differing age and comorbidity profiles, resulting in contrasting age-specific sex differences in the risk of adverse outcomes between the youngest and oldest age groups.

Time trends in income-related disparity in incidence of acute coronary syndrome.

Higher incidence of acute coronary syndrome (ACS), among those with lower income, has been recognized in the most recent decades. Still, there is a paucity of data on temporal changes. This study aims to investigate 20-year time trends in income-related disparity in the incidence of ACS in Denmark. This Population-based repeated cross-sectional study included all patients with first-time ACS, aged ≥20 years, registered in the Danish National Patient Registry 1998-2017. Aggregated sociodemographic data for the Danish population was accessed from Statistics Denmark. Yearly incidence rates (IR) and incidence rate ratios (IRR), with the highest-income quartile as a reference, were standardized using cell-specific personal equivalent income according to year, sex and age group with 95% confidence intervals. Interaction analysis was executed for differences in IR of ACS between the lowest- and highest-income quartile over time. A total of 220 070 patients hospitalized with ACS from 1998 to 2017 were identified. The yearly standardized ACS IRs decreased in all income quartiles. However, the IR remained higher in the lowest-income quartile compared to the highest for both men [1998: IRR 1.45 (95% confidence interval, CI 1.39-1.52) and 2017: 1.47 (1.40-1.54)] and women [1998: IRR 1.73 (1.64-1.82) and 2017: 1.76 (1.65-1.88)]. Interaction analysis showed that over the period the difference in IR between the lower- and the highest-income quartile decreased with 1-5 ACS cases per 100 000 person-year. Income-related disparity in the incidence of ACS was present in Denmark between 1998 and 2017. Despite a marked overall decrease in the yearly ACS incidence, the extent of income-related disparity remained unchanged.

Sex Differences in Clinical Outcomes Following First-Time Acute Coronary Syndrome in New Zealand

Clinical outcomes following acute coronary syndrome (ACS) are documented to vary by sex in several studies. This study reports short- and long-term outcomes by sex in a large cohort of New Zealanders admitted to hospital for a first-time ACS. Patient profiles were linked to national hospitalisation and mortality datasets; those admitted with a first-ACS between 1 January 2010 and 31 December 2016 were included. Clinical characteristics and adverse clinical outcomes (30-day and 2-year events) were compared between men and women. The primary outcome was time from admission to first cardiovascular readmission or all-cause death. A total of 63,245 people were admitted with first-ACS (40% women). Compared with men, women were older (mean 73 vs 66 years; p<0.001) and more likely to have a history of atherosclerotic cardiovascular disease (CVD) (27% vs 24%; p<0.001) and heart failure (11% vs 7%; p<0.001). At 30 days after admission, women had higher rates of unadjusted death/cardiovascular readmission than men (women 16%, men 12%; p<0.001) and at 2 years (women 44%, men 34%; p<0.001). In an unadjusted Cox proportional hazards model, women were at higher risk of adverse events after discharge than men at 2 years (HR 1.37, 95% CI 1.34–1.41; p<0.001, Figure 1a). After multivariable adjustment (age, ethnicity, NZ deprivation index, history of atherosclerotic CVD, history of heart failure), women were at marginally lower risk of death/readmission than men (adjusted HR 0.97; 95% CI 0.94–0.99; p=0.014, Figure 1b). Women have higher short- and long-term crude rates of death/cardiovascular readmission after first-ACS. These differences appear to be explained by age, social determinants, and prior disease burden.

Temporal trends in socioeconomic disparity in clinical outcomes for patients with acute coronary syndrome

AimsSocioeconomic factors are well-established determinants of clinical outcomes among patients with acute coronary syndrome (ACS) although quality of care has improved the last decades. This study aims to investigate 20-years temporal trends of socioeconomic disparity in 1-year incidence of major adverse cardiac events (MACE) among ACS patients in Denmark. MethodsThis population-based cohort study included all incident ACS patients in the Danish National Patient Registry during 1998–2017. Socioeconomic disparity was assessed by income and educational level. Patients were followed 1-year for MACE; defined as all-cause mortality, recurrent ACS, revascularization, stroke, or cardiac arrest. Adjusted MACE incidence rates (aIR) and hazard rate ratios (aHR) were computed with 95 % confidence intervals (CI) for five-year-periods. Changes in trends were examined from interaction analyses between the HR for five-year-periods and income and education, respectively. ResultsThe study included 220,887 patients with first-time ACS. The incidence of MACE decreased within all income and education levels. In 1998–2002 the MACE aIR among patients with low income was 885[95%CI:863–907] versus 733[711–756]/1000-person-year among those with high income (aHR: 1.19[95%CI:1.15–1.23]). The aIRs decreased to 506[489–522] and 405[388–423]/1000-person-year, respectively, in 2013–2017 (aHR: 1.23[1.17–1.29]). The aIRs of MACE decreased correspondingly within all educational levels from 1998 to 2002 to 2013–2017. However, the socioeconomic disparity according to the interaction analyses persisted both according to income and educational level. ConclusionAlthough 1-year clinical outcomes following ACS has improved substantially over the last decades, socioeconomic disparity persisted both according to income and education level.

Predictive value of triglycerides to high density lipoprotein ratio in patients with first attack of acute coronary syndrome.

To identify patients who are at risk for a first cardiovascular event, mitigate the risk, and institute early intervention. The triglyceride to high-density lipoprotein-C (TG/HDL-C) ratio has been found to be a very useful biomarker for directing treatment and prevention therapy. This retrospective cross-sectional study included adult patients (aged >18 years) experiencing first-time acute coronary syndrome (ACS). We examined all patient databases for a definite diagnosis of angina, non-ST segment elevation myocardial infarction (NSTEMI), or ST-segment elevation myocardial infarction (STEMI). Lipid profiles were obtained prior to or at the time of admission. A total of 265 patients were included in the study (mean age 57.83 ± 11.4 years) and 79.2% were men. Male gender, presence of diabetes, raised total cholesterol, raised low-density lipoprotein (LDL), and raised troponin level on admission were significantly positively correlated with STEMI (p=0.004, p=0.001, p<0.001, and p<0.001), whereas TG/HDL-C ratio was significantly negatively correlated with STEMI (p=0.048), while there was no significant results with NSTEMI (p=0.264) and angina (p=0.326). Total cholesterol and raised low-density lipoprotein (LDL) were significantly positively correlated with NSTEMI (p=0.013 and p=0.024). Patients with first-time ACS may not have an increased TG/HDL-C ratio. High LDL levels had the most significant association with an ACS event, along with total cholesterol and diabetes. Further research is needed on a larger scale to determine the association of TG/HDL-C ratio with ACS and differentiate the different types of ACS events according to their clinical and laboratory characteristics.

Prognostic modelling of clinical outcomes after first-time acute coronary syndrome in New Zealand

ObjectiveThe Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS) was established to investigate the drivers of secondary events after first-time acute coronary syndrome (ACS), including addressing inequitable outcomes by...

Incident Gout and Risk of First-Time Acute Coronary Syndrome: A Prospective, Population-Based Cohort Study in Sweden.

To investigate the risk of first-time acute coronary syndrome (ACS) in a large cohort of primary and secondary care patients with incident gout compared to the general population. Using register data for the period 2007-2017, we conducted a prospective, population-based cohort with 20,146 patients with incident gout (mean age 65.6 years; 67.4% male) and 83,517 matched population controls without prior history of coronary heart disease. We calculated incidence rates (IRs) and hazard ratios (HRs) adjusted for baseline comorbidities and dispensed prescriptions. In a sensitivity analysis, we included gout cases and controls with no previously diagnosed comorbidity (6,075 cases and 44,091 controls). The IR of first-time ACS was significantly increased in the gout cohort compared to controls (9.1 versus 6.3 of 1,000 person-years). Unadjusted Cox regression showed that gout patients had higher risk of first-time ACS compared to controls (HR 1.44 [95% confidence interval (95% CI) 1.33-1.56]), with a higher HR in women (HR 1.64 [95% CI 1.41-1.90]) than in men (HR 1.36 [95% CI, 1.24-1.50]). In multivariable analysis, the risk diminished but remained significant (HR 1.15 [95% CI 1.06-1.25]). The risk was similar in the sensitivity analysis (HR 1.20 [95% CI 1.01-1.44]) and still higher in women (HR 1.34 [95% CI 0.86-2.08]) than in men (HR 1.18 [95% CI 0.97-1.44]). Patients with incident gout have a 44% increased risk of first-time ACS, higher in women than in men. This risk is largely explained by the underlying comorbidities, but there is still a modestly increased risk that may be due to gout-related factors.

Prognosis of acute coronary syndrome stratified by cancer type and status - a nationwide cohort study

To investigated the prognosis of the most prevalent cancers (breast-, gastrointestinal-, and lung cancer), according to cancer status (i.e., active-, non-active-, history of-, and no cancer), following first-time of acute coronary syndrome (ACS). Danish nationwide registers were used to identify patients with first-time ACS from 2000-2018. Patients were stratified according to cancer type and status. Hazard ratios (HR) estimated by adjusted Cox regression models for 1year all-cause mortality reported. Further absolute risks of 1year cardiovascular versus non-cardiovascular death and 30-day cumulative incidence of coronary angiograms (CAG) was estimated, using the Aalen-Johansen non-parametric method, with competing risk of death. We identified 150,478 (95.7%) with no cancer, 2,370 (1.5%) with history of cancer, 2,712 (1.7%) with non-active cancer and 1,704 (1.1%) with active cancer. Cancer patients were older with more comorbidities than patients with no cancer. When compared with no cancer, we found HRs (95% confidence intervals) of 1.71 (1.44-2.02), 2.47 (2.23-2.73) and 4.22 (3.87-4.60) correspondingly for active breast-, gastrointestinal-, and lung cancer. Increased HRs were also found for non-active cancers, but not for history of cancer. Cardiovascular disease was the leading cause of death in all patients. Among patients with active breast-, gastrointestinal-, and lung cancer 43%, 43%, and 31% underwent CAG, correspondingly, compared with 77% of patients without cancer. Active- and non-active cancers were associated with an increased 1-year all-cause mortality compared with patients with history of cancer and no cancer. Cardiovascular disease was the leading cause of death; notably CAG was less frequently performed in cancer patients.

Acute coronary syndrome during pregnancy and postpartum in France: the nationwide CONCEPTION study

Cardiovascular diseases, including acute coronary syndromes, are the leading cause of maternal death in many developed countries. We assessed acute coronary syndrome incidences during pregnancy, peripartum, and postpartum periods. We also compared overall pregnancy (ie, covering all 3 periods) incidence with that found in nonpregnant women of childbearing age. All women aged between 15 and 49 years without ischemic heart disease who delivered between 2010 and 2018 in France were included in the CONCEPTION cohort. Data were extracted from the French National Health Insurance Information System database. Acute coronary syndromes were defined according to the International Classification of Diseases, Tenth Revision codes recorded in the principal hospital diagnosis. We used Poisson regression to estimate crude acute coronary syndrome incidences, and tested age-adjusted Poisson models to compare the incidence risk ratio of acute coronary syndrome between pregnant and nonpregnant women, with 95% confidence intervals. Among 6,298,967 deliveries in France, we observed 225 first-time acute coronary syndrome diagnoses during overall pregnancy (overall pregnancy-related acute coronary syndrome incidence, 4.34/100,000 person-years; 1 case/23,000 pregnancies). In multivariate analysis, independent factors associated with acute coronary syndrome were age, social deprivation, obesity, tobacco use, chronic hypertension, and hypertensive disorders of pregnancy (all P<.05). Among the nonpregnant women aged 15 to 49 years in the general French population, 18,247 cases of acute coronary syndrome (incidence, 16.5/100,000 person-years) occurred throughout the whole study period (>100 million person-years). Compared with the acute coronary syndrome incidence in nonpregnant women, age-adjusted overall pregnancy-related acute coronary syndrome incidence was lower (incidence rate ratio, 0.76; 95% confidence interval, 0.57-0.98; P<.05). Although compared with nonpregnant women, age-adjusted incidence rates were lower during pregnancy, risk was increased during peripartum and postpartum periods. With an incidence of 4.34 per 100,000 person-years, acute coronary syndrome still accounts for a significant proportion of maternal mortality. The peripartum and postpartum periods remain high-risk periods, and greater efforts should be made in terms of acute coronary syndrome prevention, especially because several cardiovascular risk factors are treatable, such as tobacco use and hypertensive disorders of pregnancy.

Prognosis and antithrombotic practice patterns in recurrent and transient atrial fibrillation following acute coronary syndrome: a nationwide study

Abstract Background First-time detected atrial fibrillation (AF) during acute coronary syndrome (ACS) aggravates the prognosis and increases the risk of ischemic stroke. In this setting, AF may present as brief and transient or with recurrent episodes after discharge. However, data on the association between transient or recurrent AF and ischemic stroke in patients with ACS are sparse. Further, despite being associated with ischemic stroke, first-time detected AF patients have been reported with low oral anticoagulation (OAC) rates. Purpose To examine the associated rate of ischemic stroke and mortality in ACS survivors with transient or recurrent AF and to assess the antithrombotic practice patterns one year after ACS. Methods Using data from Danish nationwide registries, we identified all patients with first-time ACS, without known AF prior to ACS, from 2000–2017 who were alive one year after ACS discharge (index date). According to a grace period between ACS discharge and one year after ACS discharge, patients were categorized into: i) no AF; ii) first-time detected AF during ACS admission without AF recurrence (transient AF); and iii) first-time detected AF during ACS admission with a subsequent recurrent AF episode (recurrent AF). Patients who developed AF during the grace period were excluded. Patients were followed from one year post ACS discharge, and two-year rates of ischemic stroke and mortality were compared using multivariable adjusted Cox proportional hazards analysis. Further, we assessed the prescribed OAC rates in a three-month period following the index date. Results We included 116,793 patients surviving one year post ACS discharge: 111,708 (95.6%) without AF (64.9% male, median age 64 years), 2,671 (2.3%) with transient AF (58.0% male, median age 74 years), and 2,414 (2.1%) with recurrent AF (55.2% male, median age 76 years). The cumulative two-year incidence of ischemic stroke was 0.9%, 1.5%, and 2.3% for patients without AF, transient AF, and recurrent AF, respectively (Figure 1). The cumulative two-year incidence of mortality was 7.4%, 12.1%, and 20.3% for patients without AF, transient AF, and recurrent AF, respectively (Figure 1). Compared to those without AF, the adjusted two-year rates of outcomes were as follows: ischemic stroke: HR 1.15 (95% CI: 0.81–1.61) for patients with transient AF and HR 1.50 (95% CI: 1.14–1.98) for patients with recurrent AF; mortality: HR 0.98 (95% CI: 0.87–1.10) for patients with transient AF and HR 1.35 (95% CI: 1.23–1.49) for patients with recurrent AF (Figure). We identified that 20.9% for transient AF and 42.2% for recurrent AF were prescribed OAC therapy in the three-month period after one year. Conclusion In patients surviving one year after ACS with first-time detected AF, a recurrent AF episode was associated with an increased long-term rate of ischemic stroke and mortality, while transient AF yielded no statistically difference as compared with patients without AF. Funding Acknowledgement Type of funding sources: None.

Prognosis following acute coronary syndrome according to cancer type and status – a nationwide Danish cohort study

Abstract Background Survival of patients with cardiovascular disease and cancers has increased due to improved treatments. However, the prognosis of acute coronary syndrome (ACS) in cancer patients is widely unknown, challenging clinical decision-making. Purpose To investigate prognosis and selected treatment strategy for the most prevalent cancers (breast, gastrointestinal and lung cancer), according to cancer status, following first-time ACS. Methods Using Danish, nationwide registers, we identified patients with ACS from 2000 through 2018. Patients were stratified according to cancer status as either “no cancer”, “history of cancer” (no hospital contact for cancer within five years), “non-active cancer” (curative intended treatment, with hospital contacts within five years) and “active cancer”. Follow-up began at the date of ACS admission. The primary outcome was 1-year absolute risk (AR) of all-cause mortality and cardiovascular- or non-cardiovascular mortality. The secondary outcome was a 30-day cumulative incidence of undergoing coronary angiogram (CAG). Cumulative incidences and AR were estimated non-parametrically with the Aalen-Johansen non-parametric method, accounting for competing risk of death when relevant. A 95% confidence interval (CI) was reported for these estimates. Results We identified a total of 157,264 patients with ACS; 150,478 (95.7%) had no cancer, 2,370 (1.5%) were identified with history of cancer, 2,712 (1.7%) with non-active cancer and 1,704 (1.1%) with active cancer. Patients with cancer were older with more comorbidities than patients with no cancer. One-year AR of all-cause mortality for active cancers compared with no cancer was 44% (95% CI: 38.2–49.4) for breast cancer, 58% (95% CI: 54.2–61.8) for gastrointestinal cancers and 73% (95% CI: 70.3–76.7) for lung cancer, compared with 18% (95% CI: 17.3–17.6) for no cancer (Figure 1). Cardiovascular disease was the leading cause of death in all patients as seen in Figure 2. For patients with non-active cancer, the cumulative incidence of having a CAG performed was 61% (95% CI: 56.9–65.7) for breast cancer, 57% (95% CI: 53.7–60.7) for gastrointestinal cancers and 59% (95% CI: 51.3 to 65.6) for lung cancer, compared to 77% (95% CI: 76.7–77.4) for no cancer. For patients with active cancer, the cumulative incidence dropped to 43% (95% CI: 35.7–50.9), 43% (95% CI: 37.0–48.3) and 31% (95% CI: 27.1–35.3) for respectively breast-, gastrointestinal and lung cancer. Conclusion The 1-year AR of all-cause mortality of cancer patients increased incrementally (no cancer &amp;lt; history of cancer &amp;lt; non-active cancer &amp;lt; active cancer) for all cancer types, with breast cancer having the lowest rates. Cardiovascular disease was the leading cause of death in all patients. However, CAG was performed less frequently in patients with non-active- and active cancer, irrespective of cancer type – altogether indicating the importance of incorporating cancer type and status, when planning treatment strategy. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Karen Elise Jensen Foundation and Helsefonden

960Dietary intakes of patients with first Acute Coronary Syndrome: the MENZACS study

Abstract Background In New Zealand (NZ) approximately 10,000 people experience an acute coronary syndrome (ACS) annually. Little is known about the diets of people who present with first ACS. Methods The Multi-Ethnic NZ study of Acute Coronary Syndromes (MENZACS) is a multi-centre, longitudinal cohort study of patients with first-time ACS. At baseline, patients complete a validated short food frequency questionnaire (FFQ) asking about dietary intakes in the 12 months preceding their event. Participants are followed up for rehospitalisation and mortality. Results Here we present the dietary intakes of the 2,015 participants enrolled into MENZACS. We excluded 90 participants who did not start the FFQ and 42 participants who had extreme energy intakes. For men (n = 1489), the median energy intake was 8637 kJ, and the median percentage of energy from carbohydrate, protein, fat, and saturated fat were 40.3%, 17.9%, 34.7% and 17.8%, respectively. For women (n = 394), the median energy intake was 7499 kJ, and the median percentage of energy from carbohydrate, protein, fat and saturated fat were 40.3%, 18.4%, 35.6%, and 18.0%, respectively. Conclusions Both men and women reported high saturated fat intakes in the year preceding their first ACS. Future work will examine dietary predictors of rehospitalisation and mortality, as well as analyse baseline blood samples for Lipoprotein(a) and lipidomics. Key messages Patients in hospital with first time ACS are able to complete a short food frequency questionnaire, with little missing data.

The Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS): Design and Methodology

Background. Each year, approximately 5000 New Zealanders are admitted to hospital with first-time acute coronary syndrome (ACS). The Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS) is a prospective longitudinal cohort study embedded within the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry in six hospitals. The objective of MENZACS is to examine the relationship between clinical, genomic, and cardiometabolic markers in relation to presentation and outcomes post-ACS. Methods. Patients with first-time ACS are enrolled and study-specific research data is collected alongside the ANZACS-QI registry. The research blood samples are stored for future genetic/biomarker assays. Dietary information is collected with a food frequency questionnaire and information about physical activity, smoking, and stress is also collected via questionnaire. Detailed family history, ancestry, and ethnicity data are recorded on all participants. Results. During the period between 2015 and 2019, there were 2015 patients enrolled. The mean age was 61 years, with 60% of patients aged &lt;65 years and 21% were female. Ethnicity and cardiovascular (CV) risk factor distribution was similar to ANZACS-QI: 13% Māori, 5% Pacific, 5% Indian, and 74% NZ European. In terms of CV risk factors, 56% were ex-/current smokers, 42% had hypertension, and 19% had diabetes. ACS subtype was ST elevation myocardial infarction (STEMI) in 41%, non-ST elevation myocardial infarction (NSTEM) in 54%, and unstable angina in 5%. Ninety-nine percent of MENZACS participants underwent coronary angiography and 90% had revascularization; there were high rates of prescription of secondary prevention medications upon discharge from hospital. Conclusion. MENZACS represents a cohort with optimal contemporary management and will be a significant epidemiological bioresource for the study of environmental and genetic factors contributing to ACS in New Zealand’s multi-ethnic environment. The study will utilise clinical, nutritional, lifestyle, genomic, and biomarker analyses to explore factors influencing the progression of coronary disease and develop risk prediction models for health outcomes.

Outcomes Among Patients With First-Time Acute Coronary Syndromes in New Zealand: The Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS)

Each year approximately 5,000 New Zealanders are admitted to hospital with a first-time acute coronary syndrome (ACS). The Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS) study aims to examine the relationship of clinical, genomic and cardiometabolic markers in relation to presentation and outcomes post-ACS.

Outcomes for working age patients after first-time acute coronary syndrome – ANZACS-QI 35

BackgroundAcute coronary syndrome (ACS) events and the ongoing burden of disease can have a significant impact on the subsequent life-course of working age people. MethodsWe report 12-month clinical outcomes for 10,822 patients hospitalized with first-time ACS between 2015-2016 and enrolled in the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry, with a focus on people of working age (defined as <65 years). ResultsNearly half (48%) of first-time ACS occurred in people of working age. Compared to those >65 years, these patients had a high burden of cardiovascular risk factors, and were more likely to be male (75% vs 60%), to be of non-European ethnicity (36% vs 15%), and to be living in areas of high deprivation. Subsequent clinical events were common in the younger patients, with 15% dying or being readmitted for cardiovascular causes within 12 months despite high rates of angiography (96%), revascularization (74%) and evidence-based medical therapy at the time of the index ACS event. ConclusionsThe high risk factor burden and subsequent high rate of clinical events in working age patients reinforces the need for a longer-term focus on strategies to improve clinical outcomes following first-time ACS.

A028 The Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS): Baseline Characteristics of Patients With First-time ACS

Each year, approximately 5000 New Zealanders are admitted to hospital with a first-time acute coronary syndrome (ACS). The aim of the Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS) is to examine the relationship of clinical, genomic and cardiometabolic markers in relation to presentation and outcomes post-ACS. MENZACS is a prospective, longitudinal cohort study embedded within the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) programme in 6 hospitals. Patients with first-time ACS were enrolled and study-specific research data collected alongside the ANZACS-QI registry. Research blood samples were stored for future genetic/biomarker assays. We report here the baseline characteristics of the MENZACS cohort and compare to the ANZACS-QI registry (first-time ACS). Between 2015-2019, 2026 patients were enrolled, mean age 61yrs, 21% were female. Ethnicity and CV risk factor distribution was similar to ANZACS-QI: 13% Māori, 5% Pacific, 5% Indian and 74% NZ European. CV risk factors included 56% ex-/current smoker, 42% hypertension, 18% diabetes. 60% of the patients were aged < 65 years. ACS subtype for MENZACS vs ANZACS-QI: STEMI 40% vs 31%, NSTEMI 52% vs 59%. 99% had coronary angiography and 90% had revascularisation; there were high rates of secondary prevention medications (table).Tabled 1Discharge MedicationAspirin1927 (98%)Dual antiplatelet therapy1611 (82%)Statin1922 (97%)Beta-blocker1652 (84%)ACEi/ARB1550 (79%) Open table in a new tab MENZACS represents a cohort with optimal contemporary management and will be a significant epidemiological bioresource for the study of environmental and genetic factors contributing to ACS in New Zealand's multi-ethnic environment. The study will utilise clinical, nutritional, lifestyle, genomic and biomarker analyses to explore aetiological factors and develop risk prediction models for outcome.

An Observational Study on Incidence of Ischemic Mitral Regurgitation Following First-Time Acute Coronary Syndrome

An Observational Study on Incidence of Ischemic Mitral Regurgitation Following First-Time Acute Coronary Syndrome

Acute coronary syndrome registry enrolment status: differences in patient characteristics and outcomes and implications for registry data use (ANZACS-QI 36)

Clinical registry-derived data are widely used to represent patient populations. In New Zealand (NZ), a national registry - the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry - aims to include all patients undergoing coronary angiography; other acute coronary syndrome (ACS) patients are also registered but without complete capture. This study compares national hospitalisation data of all first-time ACS admissions in NZ with patients in the ANZACS-QI registry, to investigate the use of clinical registry-derived data in research and in assessing clinical care. Patients admitted with first-time ACS in the NZ National Hospitalisation Dataset between 01/01/2015-31/12/2016 were included. Clinical characteristics and time to 12-month clinical outcomes were compared between patients captured and not-captured in the registry. 16,569 patients were admitted with first-time ACS, median age 69 years, 61% male; 60% (n = 9918) were enrolled in ANZACS-QI. Registry-captured patients were younger, more often male, and with a lower comorbidity burden than non-captured patients. Overall, 16% patients died within 12 months, 15% experienced a non-fatal cardiovascular readmission and 28% either died or were readmitted. Patients not captured in the registry were more than twice as likely to have experienced death or a non-fatal cardiovascular readmission within 12 months as captured patients. First-time ACS patients captured in the ANZACS-QI registry had very different clinical characteristics and outcomes than those not captured. Cardiovascular registry-derived data is dependent on registry design and may not be representative of the wider patient population; this must be considered when using registry-derived data.

Association of Prediabetes With Higher Coronary Atherosclerotic Burden Among Patients With First Diagnosed Acute Coronary Syndrome.

Diabetes mellitus (DM) is associated with more extensive coronary atherosclerosis and more vulnerable plaque phenotypes. However, DM should not be considered a homogeneous and purely binary entity in terms of risk assessment. We evaluated the impact of prediabetic status on coronary atherosclerosis burden in patients with first-time acute coronary syndrome (ACS) who underwent urgent coronary angiography. The patients were divided into DM, prediabetes, and control groups. The 3-vessel disease (TVD) rates and SYNTAX and Gensini scoring systems for defining atherosclerotic burden were compared. The study was conducted in 469 consecutive patients admitted with a diagnosis of ACS. Of these, 250 patients were admitted at the first occurrence of ACS undergoing diagnostic coronary angiography. SYNTAX and Gensini scores and TVD rates were higher in prediabetic patients than in nondiabetic patients ( P = .004, P = .008, and P = .014, respectively), but similar in prediabetic and diabetic patients ( P = .912, P = .773, and P = 1.000, respectively). Coronary atherosclerosis burden is more advanced in prediabetic patients than in nondiabetic patients and is comparable between prediabetic and diabetic patients at first presentation of ACS. Cardiologists should not miss the opportunity to diagnose prediabetes and DM when patients present with an ACS.