Abstract 17478: Relationship Between Temporal Distribution of Coronary Artery Disease Progression and Subsequent Consequences in Patients With Acute Coronary Syndromes
Background: Recent reports have shown that the late consequences of presentation with ACS has been underestimated. The relationship between temporal distribution of clinically silent progression of coronary artery disease and subsequent consequences with ACS is unclear.
Methods: We studied 217 patients (182 men, 64 ± 10 years) with ACS undergoing percutaneous coronary intervention (PCI) for culprit lesion during initial hospitalization. All patients underwent serial coronary angiograms (CAGs) immediately before PCI, and at 8 ± 2 months and 60 ± 10 months after presentation. Coronary artery disease progression (CP) was defined as an increase >= 15 % in stenosis severity of lesion in nonculprit artery between 2 serial CAGs. The relationship of CP between each of 2 serial CAGs and subsequent clinical events after final CAG was examined. Major adverse cardiac events (MACEs) were defined as death, myocardial infarction, unstable angina, heart failure, and ischemic stroke.
Results: During median follow-up duration after final CAG of 48 months, 54 MACEs (10 death, 7 myocardial infarction, 17 unstable angina, 15 heart failure, 5 ischemic stroke) were observed. Kaplan-Meier curves demonstrated a significant difference in event-free survival according to CP between each of 2 serial CAGs (Fig.). Cox regression analysis revealed that CP between first and second CAGs (OR 2.34, 95% CI 1.37 to 4.00, p=0.002), CP between second and final CAGs (OR 2.82, 95% CI 1.65 to 4.80, p<0.001), and eGFR on initial admission < 60 ml/min/1.73m2 (OR 1.86, 95% CI 1.09 to 3.19, p=0.023) were the independently associated with MACE beyond final CAG.
Conclusion: Both of CP in the early phase (0 - 8 months) and CP in the late phase (8 - 60 months) during the 5 years after ACS were independently associated with the subsequent clinical event. This may indicate prognostic significance of the persistency of the widespread coronary disease activity following presentation in patients with ACS undergoing PCI.
Author Disclosures: T. Nakachi: None. H. Kirigaya: None. D. Gyotoku: None. N. Iinuma: None. N. Ishii: None. Y. Miki: None. K. Iguchi: None. K. Fukui: None. S. Umemura: None. K. Kimura: None.
- © 2014 by American Heart Association, Inc.