P3612Validation of Charlson Comorbidity Index to predict adverse events in elderly patients with Atrial Fibrillation and Acute Coronary Syndrome: an analysis from LONGEVO-SCA Registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M A Esteve Pastor ◽  
E Marin ◽  
O Alegre ◽  
J C Castillo Dominguez ◽  
F Formiga ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Acute Coronary Syndrome ◽  
Adverse Events ◽  
Elderly Patients ◽  
Predictive Performance ◽  
Coronary Syndrome ◽  
C Statistic ◽  
All Cause Mortality ◽  
Comorbidity Index

Abstract Background Aging is frequently characterized by the coexistence of several comorbid conditions that increase the adverse prognosis during hospitalization. There are few scores to analyze the impact of comorbidities in prognosis. Charlson Comorbidity Index (CCI). This score evaluates the burden of comorbidity in general population but the influence within cardiac diseases is unknown. Purpose The aim of this study was to analyze the relationship of CCI in adverse outcomes at short-term follow-up in elderly patients with atrial fibrillation (AF) admitted after an acute coronary syndrome (ACS). Methods The prospective multicenter LONGEVO-SCA included unselected elderly patients hospitalized after non-STACS. In this substudy, we analyze the influence of comorbidities in elderly AF patients, comparing high quartiles of CCI (Q3-Q4: high burden of comorbidities) to low quartiles (Q1-Q2) and the predictive performance of adverse events at 6 months follow-up of CCI. Results We analyzed 531 patients (mean age 84.4±3.6 years; 322 (60.6%) male). 128 (24.1%) had AF diagnosis. 91 (71.1%) patients were classified into Q1-Q2 and 37 (28.9%) patients into Q3-Q4. We analyzed the association of clinical factors and adverse events and, after Cox multivariate regression analysis, CCI was independently associated with readmissions [HR 1.19, 95% CI (1.02–1.39); p=0.020) and all-cause mortality [HR 1.32, 95% CI (1.09–1.59); p=0.003]. Patients into Q3-Q4 had higher risk of mortality than patients into Q1-Q2 [HR 5.52, 95% CI (1.01–30.3); p=0.049]. Kaplan Meier analysis showed that AF patients into Q3-Q4 had significantly worse prognosis during the follow-up with high risk of all-cause mortality (p=0.034) and readmissions due to ACS (p=0.027). We observed good predictive performance of CCI for mortality (c-statistic 0.705; p<0.001) and modest predictive performance for readmissions (c-statistic 0.627; p<0.001). Event Free Survival according Charlson Conclusions Patients into high quartiles of CCI had higher risk of adverse events during the follow-up. CCI was an independent predictor of all-cause mortality and readmissions in elderly patients. Indeed, this is the first time to validate CCI to predict adverse events in AF patients with ACS.

P1752Impact of frailty addition in ischemic and bleeding risk scores in elderly patients with Atrial Fibrillation and Acute Coronary Syndrome: a subanalysis from LONGEVO-SCA registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M A Esteve Pastor ◽  
E Martin ◽  
O Alegre ◽  
J C Castillo Dominguez ◽  
F Formiga ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Acute Coronary Syndrome ◽  
Adverse Events ◽  
Elderly Patients ◽  
Predictive Performance ◽  
Risk Scores ◽  
Coronary Syndrome ◽  
C Statistic ◽  
The Impact ◽  
Grace Score

Abstract Background The prevalence of Atrial Fibrillation (AF) and Acute Coronary Syndrome (ACS) increases with age. Frail older adults are at high risk of multiple adverse events during admission and short term mortality. FRAIL score is an easy tool that evaluates: fatigue, resistance, ambulation, concomitant diseases and weight loss. Purpose The aim of this study was to validate FRAIL score in AF elderly patients with ACS related to adverse events and the impact of its addition in clinical scores. Methods The prospective multicenter LONGEVO-SCA enrolled unselected elderly patients hospitalized after non-STACS. We analyzed the predictive performance of FRAIL score in AF subgroup for adverse events (primary endpoint mortality or readmission) and the impact of frailty addition in ischaemic and bleeding scores. Results We analyzed 531 patients. 128 (24.1%) of them have AF (main age 84.6±3.7 years; 78 (61%) male) and 27.3% were frail (defined by FRAIL score ≥3). Frail AF patients had more prevalent comorbidities and received less evidence-based ACS therapies at discharge as oral anticoagulation (66% vs 60%; p<0.001) or statins 96.3% vs 82.6%; p<0.001). We analyzed the predictive performance of FRAIL score to adverse events and observed a modest predictive performance for mortality (c-statistic 0.648; 95% CI [0.605–0.690]; p<0.001), readmissions (c-statistic 0.600; 95% CI [0.557–0.642]; p<0.001) and for composite endpoint (c-statistic 0.620; 95% CI [0.577–0.663]; p<0.001). We compared the addition of FRAIL score to the original risk scores and observed a significant improvement for the primary endpoint with the addition to CHA2DS2-Vasc score (p=0.009), GRACE (p<0.001) and CRUSADE scores (p<0.001). (Table) C-indexes for mortality or readmissions C-index 95% CI p p* Z* CHA2DS2-VASc score 0.619 0.576 to 0.662 <0.001 0.009 2.586 CHA2DS2-VASc score + FRAIL 0.641 0.598 to 0.683 <0.001 HAS-BLED score 0.649 0.606 to 0.691 <0.001 0.445 0.764 HAS-BLED score + FRAIL 0.634 0.590 to 0.675 <0.001 GRACE score 0.599 0.554 to 0.644 0.006 0.001 3.930 GRACE score + FRAIL 0.602 0.556 to 0.646 <0.001 CRUSADE score 0.660 0.613 to 0.705 0.051 0.001 3.287 CRUSADE score + FRAIL 0.664 0.617 to 0.709 <0.001 CI: Confidence interval. *For c-index comparison. p: P value. Conclusions This is the first validation of the FRAIL score in AF patients under ACS with a modest predictive performance to adverse events. The addition of frailty to clinical scores improved the predictive performance to adverse events in AF patients.

scholarly journals J-shaped relationship between admission diastolic blood pressure and 2-year cardiovascular mortality in elderly patients with acute coronary syndrome

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C Jiang ◽  
S Wu ◽  
M Wang ◽  
H Li ◽  
X Zhao
Keyword(s):  
Blood Pressure ◽  
Acute Coronary Syndrome ◽  
Elderly Patients ◽  
Diastolic Blood Pressure ◽  
Lower Risk ◽  
Cox Regression ◽  
Cardiovascular Death ◽  
Coronary Syndrome ◽  
All Cause Mortality

Abstract Objective To investigate the relationship between admission diastolic blood pressure (DBP) and subsequent cardiovascular and all-cause mortality in elderly patients with acute coronary syndrome (ACS). Methods This is a retrospective observational study. Consecutive patients ≥65 years of age admitted for ACS at a 2,300-bed tertiary hospital from December 2012 to July 2019 were included. The association between admission DBP and cardiovascular and all-cause mortality during hospitalization and over the follow-up period among this population were analyzed using multivariate COX regression model. Results were presented according to DBP quartiles: Q1, less than 67 mm Hg; Q2, from 67 to 72 mm Hg; Q3, from 73 to 80 mm Hg; and Q4, above 80 mm Hg. Results A total of 6 785 patients were included in this cohort study. Mean (SD) patient age was 74.0 (6.5) years, and 47.6% were women. Mean (SD) follow-up time was 2.54 (1.82) years. A non-linear relation was observed between DBP at admission and cardiovascular and all-cause mortality during hospitalization and over the follow-up period using restricted cubic splines. After adjustment for potential confounders, patients in Q3 or Q2 had lower risk for 2-year cardiovascular death by Cox proportional hazard model compared with patients in Q4 (hazard ratio [HR] 0.66; 95% confidence interval [CI], 0.48–0.90, P=0.010, for Q3 vs Q4; and HR 0.72; 95% CI, 0.53–0.99, P=0.041, for Q2vs Q4), while patients in Q1 had similar risk for cardiovascular death with that of patients in Q4. Meanwhile, when compared with patients in Q1, patients in Q3 had lower risk for 2-year cardiovascular death (HR, 0.72; 95% CI, 0.53–0.97, P=0.033). However, lower or higher admission DBP was not an independent predictor of 2-year all-cause mortality in this population. Conclusion Among patients aged ≥65 years admitted for ACS, there is a J-curve relationship between supine admission DBP and risk for 2-year cardiovascular death, with a nadir at 73–80 mm Hg. FUNDunding Acknowledgement Type of funding sources: Other. Main funding source(s): the Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support Study population and selection Adjusted multivariate COX regression

scholarly journals Hyperuricemia is a Risk Factor for One-Year Overall Survival in Elderly Female Patients with Acute Coronary Syndrome

2020 ◽  
Vol 2020 ◽  
pp. 1-10 ◽  
Author(s):  
Shi Tai ◽  
Xuping Li ◽  
Zhaowei Zhu ◽  
Liang Tang ◽  
Hui Yang ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Risk Factor ◽  
Elderly Patients ◽  
Independent Risk Factor ◽  
Female Patients ◽  
Coronary Syndrome ◽  
Elderly Female ◽  
All Cause Mortality ◽  
The Impact

Background. Hyperuricemia is a risk factor for cardiovascular diseases, but the impact of hyperuricemia and sex-related disparities is not fully clear in elderly patients with acute coronary syndrome (ACS). Objective. To investigate the association between hyperuricemia and 1-year all-cause mortality in elderly patients with ACS. Methods. This retrospective cohort study included 711 consecutive ACS patients aged ≥75 years, hospitalized in our center between January 2013 and December 2017. Serum uric acid (sUA), in-hospital events, and 1-year follow-up were analyzed. Multivariable logistic regression models were used to explore the risk factors for in-hospital events and 1-year all-cause mortality. Results. sUA levels were higher in males than in females (381.4 ± 110.1 vs. 349.3 ± 119.1 μmol/l, P<0.001). Prevalence of hypertension (80.5% vs. 72.6%, P=0.020), atrial fibrillation (16.2% vs. 9.5%, P=0.008), and severe heart failure (61.0% vs. 44.2%, P<0.001) were higher in patients with hyperuricemia than in patients with normal sUA. During the 1-year follow-up, 135 patients died (19.0%); all-cause mortality was higher in patients with hyperuricemia than in patients with normal sUA (23.1% vs. 16.7%, P=0.039). Hyperuricemia is related to in-hospital ventricular tachycardia and 1-year all-cause mortality (OR = 1.799, 95% CI 1.050–3.081, P=0.033; OR = 1.512, 95% CI 1.028–2.225, P=0.036, respectively). Multivariable regression analysis models showed that hyperuricemia was an independent risk factor of 1-year all-cause mortality in women (OR = 2.539, 95% CI 1.001–6.453, P=0.050), but not in men (OR = 0.931, 95% CI 0.466–1.858, P=0.839) after adjustment for confounding variables. Conclusions. Hyperuricemia is an independent risk factor for 1-year all-cause mortality in elderly female patients with ACS.

P2525Relationship of Charlson Comorbidity Index with adverse events in elderly patients with Acute Coronary Syndromes: an analysis from LONGEVO-SCA Registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M A Esteve Pastor ◽  
E Martin ◽  
O Alegre ◽  
J C Castillo Dominguez ◽  
F Formiga ◽  
...  
Keyword(s):  
Adverse Events ◽  
Elderly Patients ◽  
Acute Coronary Syndromes ◽  
Risk Of Mortality ◽  
All Cause Mortality ◽  
Coronary Syndromes ◽  
Comorbidity Index ◽  
The Relationship ◽  
Worse Prognosis

Abstract Background Elderly patients with Acute Coronary Syndromes (ACS) are under-represented in clinical trials and they have higher risk of new due their comorbidities. Charlson Comorbidity Index (CCI) is an established tool for evaluating the burden of comorbidity status and a high score of CCI is related with an increased risk of death. Purpose The aim of this study was to analyze the relationship of CCI in adverse outcomes at short-term follow-up in elderly patients admitted by an ACS. Methods The prospective multicenter LONGEVO-SCA included unselected elderly patients (≥80 years old) hospitalized after non-STACS. In this substudy, we analyze the influence of comorbidities, comparing the relationship between quartiles of CCI and adverse events at 6 months follow-up of CCI. Results We analyzed 520 patients (mean age 84.4±3.6 years; 320 (61.5%) male). 196 (37.6%) were classified into Q1, 105 (20.2%) into Q2, 93 (17.9%) into Q3 and 126 (24.2%) into Q4. No differences were observed in treatment at discharge across different quartiles for aspirin (p=0.648), beta-blockers (p=0.908) or statins (p=0.756). We observed a significant increase for all-cause mortality [9 (4.8%) vs 10 (10.2%) vs 11 (12.0%) vs 32 (26.0%); p<0.001] and readmissions [36 (18.4%) vs 21 (20%) vs 33 (35.5%) vs 48 (38.1%); p<0.001] respectively from Q1 to Q4. After Cox multivariate regression analysis, CCI was independently associated with mortality or readmissions [HR 1.15, 95% CI (1.06–1.26); p=0.001] and patients into high quartile had 6-fold risk of mortality [HR 6.19, 95% CI (2.95–12.99); p<0.001]. Kaplan Meier analysis showed that patients in the highest quartiles had significantly worse prognosis during the follow-up with high risk of all-cause mortality and readmissions (both p<0.001). Event Free Survival according Charlson Conclusions In LONGEVO-SCA registry, we validated for the first time CCI as an independent factor related with adverse events. Patients into high quartiles of CCI had significantly worse prognosis during the follow-up and elderly patients into Q4 had 6-fold risk of mortality compared to Q1 patients.

Does chronic kidney disease improve the predictive value of the CHADS2 and CHA2DS2-VASc stroke stratification risk scores for atrial fibrillation?

2013 ◽  
Vol 109 (05) ◽  
pp. 956-960 ◽  
Author(s):  
Vanessa Roldán ◽  
Francisco Marín ◽  
Sergio Manzano-Fernández ◽  
Hermógenes Fernández ◽  
Pilar Gallego ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Acute Coronary Syndrome ◽  
Risk Factor ◽  
Stroke Risk ◽  
Risk Scores ◽  
Coronary Syndrome ◽  
All Cause Mortality

SummaryChronic Kidney Disease (CKD) constitutes an adverse risk factor in chronic anticoagulated atrial fibrillation (AF) patients, being related to adverse cardiovascular events, mortality and major bleeds. It is unclear if CKD adds independent prognostic information to stroke risk stratification schemes, as the risk factor components of the CHADS2 and CHA2DS2-VASc scores are themselves related to renal dysfunction. The aim of our study was to determine if CKD independently improves the predictive value of the CHADS2 and CHA2DS2-VASc stroke stratification scores in AF. We recruited consecutive patients (n=978) patients (49% male; median age 76) with permanent or paroxysmal AF on oral anticoagulants with acenocoumarol, from our out-patient anticoagulation clinic. After a median follow-up of 875 (IQR 706–1059) days, we recorded stroke/transient ischaemic attack (TIA), peripheral embolism, vascular events (acute coronary syndrome, acute heart failure and cardiac death) and all-cause mortality. During follow-up, 113 patients (4.82%/year) experienced an adverse cardiovascular event, of which 39 (1.66%/year) were strokes, 43 (1.83%/year) had an acute coronary syndrome and 32 (1.37%/year) had acute heart failure. Also, 102 patients (4.35%/year) died during the following up, 31 of them (1.32%/year) as a result of a thrombotic event. Based on c-statistics and the integrated discrimination improvement (IDI), CKD did not improve the prediction for stroke/systemic embolism, thrombotic events and all-cause mortality using the CHADS2 and CHA2DS2-VASc scores. In conclusion, evaluating renal function in AF patients is important as CKD would confer a poor overall prognosis in terms of thromboembolic events and all-cause mortality. Adding CKD to the CHADS2 and CHA2DS2-VASc stroke risk scores did not independently add predictive information.Note: The review process for this manuscript was fully handled by Christian Weber, Editor in Chief.

Abstract 309: Is Right Bundle Branch Block Associated with Poor Outcomes in the Setting of an Acute Coronary Syndrome? A Systematic Review and Meta-analysis

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Ahmad Hazem ◽  
Sunita Sharma ◽  
Amit Sharma ◽  
Cameron Leitch ◽  
Roopalakshmi Sharadanant ◽  
...  
Keyword(s):  
Systematic Review ◽  
Acute Coronary Syndrome ◽  
Right Bundle Branch Block ◽  
Risk Ratio ◽  
Meta Analysis ◽  
Forest Plot ◽  
Bundle Branch Block ◽  
Coronary Syndrome ◽  
All Cause Mortality

Importance: Up to 10% of patients with acute myocardial infarction (AMI) have right bundle branch block (RBBB), and RBBB has been associated with a higher risk of mortality. We performed a systematic review and meta-analysis to determine the prognostic significance of RBBB for patients with AMI. Acute coronary syndrome (ACS) Data Sources: We have systematically searched Ovid, Scopus and Web of Science through January 2014. Study Selection: Reviewers working independently and in duplicate screened all eligible abstracts, selecting studies that described all-cause mortality or cardiovascular death in patients with RBBB and suspected ACS. We excluded studies that reported unadjusted outcomes. Knowledge synthesis: We pooled risk ratio with hazard ratio in studies reporting those outcomes. When reported, odds ratio was converted into risk ratio using reported event rate in each study’s unexposed -read: non RBBB- group. Main Outcomes: All-cause mortality and cardiovascular mortality (death). Results: Eighteen studies were found that reported eligible data. All were observational studies, involving over 89,000 patients. In short-term follow up (up to 30 days), RBBB on presentation was associated with higher all-cause mortality rate, compared to patients without RBBB (RR 2.23, 95% CI 1.76-2.82). There was a trend for higher mortality at long-term follow up (range: 6 months-16 years) that did not reach statistical significance (RR 1.45, 95% CI 0.93-2.25). Figure-1 demonstrates the forest plot. Risk of bias was assessed with the Newcastle-Ottawa scale and majority of included studied were deemed moderate to high quality. Conclusion and Relevance: RBBB is associated with a more than 2-fold higher risk of all-cause mortality in patients with AMI at 30 days follow up. Patients with AMI and RBBB represent a high risk group for adverse outcomes. A sentence on the differential findings for new vs. old RBBB and association with outcomes could follow here.

All-Cause Mortality Following an Acute Coronary Syndrome: 12-Year Follow-Up of the Comprehensive 2002 New Zealand Acute Coronary Syndrome Audit

2019 ◽  
Vol 28 (2) ◽  
pp. 245-256 ◽  
Author(s):  
Chris J. Ellis ◽  
Greg D. Gamble ◽  
Michael J.A. Williams ◽  
Phil Matsis ◽  
John M. Elliott ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
New Zealand ◽  
Coronary Syndrome ◽  
All Cause Mortality

scholarly journals Evaluation of the long-term prognostic ability of triglyceride-glucose index for elderly acute coronary syndrome patients: a cohort study

2022 ◽  
Vol 21 (1) ◽  
Author(s):  
Yang Jiao ◽  
Yongkang Su ◽  
Jian Shen ◽  
Xiaoling Hou ◽  
Ying Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Adverse Events ◽  
World Population ◽  
Coronary Syndrome ◽  
Tyg Index ◽  
All Cause Mortality ◽  
The Mean ◽  
Traditional Risk Factors

Abstract Background With the advancement of the world population aging, more attention should be paid to the prognosis of elderly patients with acute coronary syndrome (ACS). Triglyceride-glucose (TyG) index is a reliable indicator of insulin resistance (IR) and is closely related to traditional risk factors of cardiovascular disease (CVD). However, the effect of TyG index on the prognosis of long-term adverse events in elderly ACS patients has not been reported. This study evaluated the prognostic power of TyG index in predicting adverse events in elderly ACS patients. Methods In this study, 662 ACS patients > 80 years old who were hospitalized from January 2006 to December 2012 were enrolled consecutively and the general clinical data and baseline blood biochemical indicators were collected. The follow-up time after discharge was 40–120 months (median, 63 months; interquartile range, 51‒74 months). In addition, the following formula was used to calculate the TyG index: Ln [fasting TG (mg/dL) × FBG (mg/dL)/2], and patients were divided into three groups according to the tertile of the TyG index. Results The mean age of the subjects was 81.87 ± 2.14 years, the proportion of females was 28.10%, and the mean TyG index was 8.76 ± 0.72. The TyG index was closely associated with the traditional risk factors of CVD. In the fully-adjusted Cox regression model, the Hazard ratio (95% CI) of all-cause mortality (in tertile 3) was 1.64 (1.06, 2.54) and major adverse cardiac event (MACE) (in tertile 3) was 1.36 (1.05, 1.95) for each SD increase in the TyG index. The subgroup analyses also confirmed the significant association of the TyG index and long-term prognosis. Conclusion The TyG index is an independent predictor of long-term all-cause mortality and MACE in elderly ACS patients.

P5656Heart failure clinical phenotypes and outcomes in patients with atrial fibrillation: an analysis from the eurobservational research programme in atrial fibrillation long-term general registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Proietti ◽  
C Laroche ◽  
A Tello-Montoliu ◽  
R Lenarczyk ◽  
G A Dan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Acute Coronary Syndrome ◽  
Regression Analysis ◽  
Cox Regression ◽  
Adverse Outcomes ◽  
Cox Regression Analysis ◽  
Coronary Syndrome

Abstract Introduction Heart failure (HF) is a well-known risk factor for atrial fibrillation (AF). Moreover, HF is associated with worse clinical outcomes in patients with known AF. Recently, phenotypes of HF have been redefined according to the level of ejection fraction (EF). New data are needed to understand if a differential risk for outcomes exists according to the new phenotypes' definitions. Purpose To evaluate the risk of major adverse outcomes in patients with AF and HF according to HF clinical phenotypes. Methods We performed a subgroup analysis of AF patients enrolled in the EORP-AF Long-Term General Registry with a history of HF at baseline, available EF and follow-up data. Patients were categorized as follows: i) EF<40%, i.e. HF reduced EF [HFrEF]; ii) EF 40–49%, i.e. HF mid-range EF [HFmrEF]; iii) EF ≥50%, i.e. HF preserved EF [HFpEF]. Any thromboembolic event (TE)/acute coronary syndrome (ACS)/cardiovascular (CV) death, CV death and all-cause death were recorded. Results A total of 3409 patients were included in this analysis: of these, 907 (26.6%) had HFrEF, 779 (22.9%) had HFmrEF and 1723 (50.5%) had HFpEF. An increasing proportion with CHA2DS2-VASc ≥2 was found across the three groups: 90.4% in HFrEF, 94.6% in HFmrEF and 97.3% in HFpEF (p<0.001), while lower proportions of HAS-BLED ≥3 were seen (28.0% in HFrEF, 26.3% in HFmrEF and 23.6% in HFpEF, p=0.035). At discharge patients with HFpEF were less likely treated with antiplatelet drugs (22.0%) compared to other classes and were less prescribed with vitamin K antagonists (VKA) (57.0%) and with any oral anticoagulant (OAC) (85.7%). No differences were found in terms of non-vitamin K antagonist oral anticoagulant use. At 1-year follow-up, a progressively lower rate for all study outcomes (all p<0.001), with an increasing cumulative survival, was found across the three groups, with patients with HFpEF having better survival (all p<0.0001 for Kaplan-Meier curves). After full adjustment, Cox regression analysis showed that compared to HFrEF, HFmrEF and HFpEF were associated with risk of all study outcomes (Table). Cox Regression Analysis HR (95% CI) Any TE/ACS/CV Death CV Death All-Cause Death HFmrEF 0.65 (0.49–0.86) 0.53 (0.38–0.74) 0.55 (0.41–0.74) HFpEF 0.50 (0.39–0.64) 0.42 (0.31–0.56) 0.45 (0.35–0.59) ACS = Acute Coronary Syndrome; CI = Confidence Interval; CV = Cardiovascular; EF = Ejection Fraction; HF = Heart Failure; HR = Hazard Ratio. Conclusions In this cohort of AF patients with HF, HFpEF was the most common phenotype, being associated with a profile related to an increased thromboembolic risk. Compared to HFrEF, both HFmrEF and HFpEF were associated with a lower risk of all major adverse outcomes in AF patients.

scholarly journals Clinical impact of mineralocorticoid receptor antagonists treatment after acute coronary syndrome in the real world: A propensity score matching analysis

2018 ◽  
Vol 8 (7) ◽  
pp. 652-659 ◽  
Author(s):  
Rosa Agra-Bermejo ◽  
Alberto Cordero ◽  
Moisés Rodríguez-Mañero ◽  
Jose M García Acuña ◽  
Belén Álvarez Álvarez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Propensity Score ◽  
Adverse Events ◽  
Mineralocorticoid Receptor ◽  
Mineralocorticoid Receptor Antagonists ◽  
Receptor Antagonists ◽  
Coronary Syndrome

Background: Recent studies suggest that the benefit of mineralocorticoid receptor antagonists in the acute coronary syndrome setting is controversial. The aim of this study was to examine the current long-term prognostic benefit of mineralocorticoid receptor antagonists in patients with acute coronary syndrome. Material and methods: We conducted a retrospective cohort study of 8318 consecutive acute coronary syndrome patients. Baseline patient characteristics were examined and a follow-up period was established for registry of death, major cardiovascular adverse events and heart failure re-hospitalization. We performed a propensity-matching analysis to draw up two groups of patients paired according to whether or not they had been treated with mineralocorticoid receptor antagonists. The prognostic value of mineralocorticoid receptor antagonists to predict events during follow-up was analysed using Cox regression. Results: Among the study participants, only 524 patients (6.3%) were discharged on mineralocorticoid receptor antagonists. Patients on mineralocorticoid receptor antagonists had a different clinical and pharmacological profile. These differences disappeared after the propensity score analysis. The median follow-up was 40.7 months. After the propensity score analysis, the cardiovascular mortality and heart failure readmission rates were similar between patients who were discharged on mineralocorticoid receptor antagonists and those whose not. The use of mineralocorticoid receptor antagonists was only associated with a reduction in major cardiovascular adverse events (hazard ratio=0.83, 95% confidence interval 0.69–0.97, p=0.001). Conclusions: Our results do not corroborate the long-term benefit of mineralocorticoid receptor antagonists to improve survival after acute coronary syndrome in a large cohort of patients with heart failure or reduced left ventricular ejection fraction and diabetes. Their prescription was associated with a significantly lower incidence of major cardiovascular adverse events during the long-term follow-up without effect on heart failure development.

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