Abstract 3176: Differerential Impact Of Acute Myocardial Risk Factors And Chronic Comorbidities On Use Of Guideline-recommended Therapies In Patients Presenting With Acute Coronary Syndromes
Background: Prior investigations show that patients presenting with ACS with high-risk features are less likely to receive evidence-based therapies (EBT). Current risk stratification tools combine acute and chronic risk factors (RF); these may contribute differently to receipt of proven therapies.
Methods: Using data from a prospective audit of 2600 patients in Australia, the impact of acute myocardial RF (biomarker elevation, ECG changes, cardiac arrest, Killip class ≥ 2), chronic co-morbid RF (prior CHF, chronic lung disease, malignancy, prior CVA, GFR < 60, age > 75), and traditional RF on patient management were examined using logistic regression.
Results: the best predictor of receipt of EBT was the number of myocardial RF; the best predictor of a low likelihood of receipt was the number of co-morbid RF (Table⇓). The presence of three or more myocardial RF conferred an OR of 2.21 for receiving clopidogrel and 4.3 for undergoing angiography, while the presence of four or more co-morbid RF lowered the OR to 0.47 for clopidogrel and 0.09 for angiography (Figure 1a⇓/b⇓).
Conclusions: High-risk patients may be less likely to receive EBT than low-risk patients, but this is driven by comorbid conditions rather than markers of severity of illness. Research is needed to validate these therapies in high-risk patients, and ongoing efforts at quality improvement should focus on high-risk populations.