Abstract 15409: Differences in 1-Year Mortality Risk Between Survivors of ST-Segment Elevation and Non ST-Segment Elevation ACS: Insights From the EPICOR Study
Background: Patients with NSTEACS show lower short-term mortality and similar or worse long-term prognosis than STEMI patients. Contemporary information on difference in prognosis between these 2 patient groups and identification of those at highest risk is scarce.
Methods: EPICOR (NCT01171404) is a prospective, observational cohort study of 10568 consecutive hospital survivors after an ACS. Patients were enrolled from 555 hospitals in 20 European and Latin American countries between 10/2010 and 03/2011. Postdischarge mortality was recorded for 12 mo and analyzed according to ECG presentation (STEMI vs NSTEACS) and risk. For that, a new risk score was developed with forward Cox regression analysis to identify patients at different levels of risk after discharge.
Results: 403 patients (3.8%) died during the first 12 mo after discharge from index hospitalization: STEMI, 153/4943 deaths, 3.1%; NSTEACS, 250/5625 deaths, 4.4%. The risk score captured variables during hospitalization and at discharge, and selected age, male gender, PAD, COPD, poorer QoL, creatinine, blood glucose, haemoglobin, LVEF, in-hospital complications, lack of revascularization and diuretics as independent predictors of mortality. When adjusted for these variables, ECG presentation was not significantly associated with mortality (HR for STEMI vs NSTEACS 1.00; 95%CI, 0.80-1.24). For both STEMI and NSTEACS there was a steep gradient to mortality across quintiles, with 10.1% and 13.8% mortality in the top fifth, respectively. The top fifth contained a higher proportion of NSTEACS patients.
Conclusions: Postdischarge mortality for ACS patients remains of concern. The higher 1-year mortality in NSTEACS patients is largely explained by their poorer risk profile. A risk score developed to predict postdischarge mortality identifies well which patients with STEMI and NSTEACS are at higher risk. Whether the poor prognosis of these patients can be improved warrants further study.
- © 2013 by American Heart Association, Inc.