Abstract 16393: Causes and Timing of Death in Patients With NSTE ACS: An Analysis of the TIMI Trials
Background: Although early sequelae of non-ST elevation acute coronary syndromes (NSTE ACS) are well described, less is known about the longer-term risks and causes of death following NSTE ACS.
Methods: We evaluated 48,478 NSTE ACS patients enrolled in 21 Thrombolysis in Myocardial Infarction (TIMI) trials, examining their baseline characteristics and causes and timing of death.
Results: Of the 48,478 patients, 1.4% (n=656) died in the first 30 days, 2.8% (n=1349) died in the first 365 days, and 3.2% (n=1540) died by the time of last follow-up. Overall, patients who died were older (69.3±10.8 vs. 61.3±11.2 years), had more evidence of atherosclerotic disease (prior MI (40.8% vs. 26.3%), angina (62.7% vs. 47.8%), stroke (8.4% vs. 3.5%), peripheral vascular disease (15.9% vs. 6.6%), revascularization (25.4% vs. 21.8%)), and were more likely to have a history of heart failure (22.9% vs. 6.9%) than those who lived (all p<0.0001). Of the 1540 total deaths, 71.8% (n=1105) were related to a cardiovascular (CV) event, 3.6% (n=55) were related to a bleeding event (including intracranial hemorrhage), 20.0% (n=308) were related to a non-CV, non-bleeding event, and 4.7% (n=72) were unknown. The most common causes of CV death were sudden cardiac death (SCD) and recurrent myocardial infarction (MI), which represented 21.4% (n=329) and 20.4% (n=314) of all deaths, respectively. Heart failure represented 12.9% (n=198) of all deaths. The proportion of deaths attributable to recurrent MI was greater in the first 30 days than it was in the 30-365 days following the index event (26.7% vs. 17.7%), whereas the proportion of deaths attributable to SCD was lower in the first 30 days (16.9% vs. 24.7%).
Conclusions: Recurrent MI represents the largest proportion of CV deaths in the first 30 days following NSTE ACS, whereas SCD is a proportionally greater cause in the 30-365 day period. These data suggest that SCD may be an under-recognized and under-treated late cause of death following NSTE ACS.
- © 2011 by American Heart Association, Inc.