Abstract 11077: Differential Prognostic Effect of Revascularization According to Comorbidities in High-Risk Non ST-Segment Elevation Acute Coronary Syndromes
Background: Data on the effect of revascularization on outcome in patients with high-risk non ST-segment elevation acute coronary syndrome (NSTEACS) and significant comorbidities are scarce. Recently, Simple Comorbidity Index (SCI) including 5 comorbidities (renal failure, dementia, peripheral artery disease, heart failure and prior myocardial infarction) has shown to be a useful tool for risk stratification; nevertheless, therapeutic implications have not been derived. We sought to evaluate the prognostic effect attributable to revascularization in NSTEACS according SCI score.
Methods: We included 1017 consecutive patients with NSTEACS. The effect of revascularization on a combined endpoint of all-cause mortality or non-fatal myocardial infarction (MI) according to SCI categories was evaluated by Cox regression.
Results: 560 (55.1%), 236 (23.2%) and 221 (21.7%) patients showed 0, 1 and >=2 points according SCI, respectively. Coronary angiography was performed in 725 patients (71.5%) and 450 (44.3%) underwent revascularization. During a median follow-up of 16 months (IQR: 12-36), 305 (30%) patients experienced the combined endpoint [202 deaths (19.9%) and 170 MI (16.7%)]. In multivariate analysis, a differential prognostic effect of revascularization was observed comparing SCI>=2 vs 0 (p for interaction=0.008). Thus, revascularization was associated with a greater prognostic benefit in patients with SCI>=2 (HR: 0.51; CI 95%=0.29-0.89), p=0.018), whereas no significant benefit was observed in those with 0 and 1 points (HR: 1.31; CI 95%=0.88-1.94, p=0.171 and HR: 1.11; CI 95%=0.70-1.76, p=0.651, respectively).
Conclusion: In NSTEACS, SCI score appears as a useful tool for identifying a subset of patients with a significant long-term death/MI risk reduction attributable to revascularization.
- © 2011 by American Heart Association, Inc.