One-Year Prognosis for Patients Diagnosed with Acute Coronary Syndrome Compared to Those with Chronic Coronary Syndrome Following Complex Coronary Procedures

TL;DR

This study compares the one-year outcomes of patients with acute and chronic coronary syndrome after complex heart procedures, finding similar risks for major cardiac events.

Contribution

The study identifies ACS as an independent risk factor for death despite similar overall cardiac event rates in ACS and CCS patients.

Findings

The incidence of MACE at one year was comparable between ACS and CCS patients (12.4% vs. 7.6%).

ACS is an independent risk factor for death at one-year follow-up.

Age, heart failure, and lesion characteristics are key predictors of adverse outcomes.

Abstract

Background: Acute coronary syndrome (ACS) remains the primary cause of mortality worldwide. Performing complex coronary intervention in patients with ACS is considered a significant factor for worsening prognosis. This study aimed to evaluate the prognosis of patients with ACS treated with complex procedures compared to patients with chronic coronary syndrome (CCS). Methods: Among 980 patients from the Polish Complex Registry, we enrolled 829 consecutive patients who underwent complex percutaneous coronary intervention (PCI) for acute or chronic coronary syndrome with a completed one-year follow-up. The primary endpoint is defined as the major adverse cardiac event (MACE) at 12 months, a composite endpoint including all-cause death, target lesion revascularization, target vessel revascularization, and non-fatal myocardial infarction. Results: The incidence of the composite endpoint of MACE at one-year follow-up was comparable between the patients with acute and chronic coronary syndrome who underwent complex PCI (12.4% vs. 7.6%, LogRank p = 0.035). Cox multivariate analysis indicated that ACS is an independent risk factor for death at one-year follow-up. Additionally, age and comorbidities, such as heart failure and chronic kidney disease, along with procedural factors, including lesion length and pre-procedural diameter stenosis, are independent predictors of death in patients with complex lesions. Independent risk factors for MACE at one-year follow-up include age, heart failure, previous PCI, in-stent restenosis, and pre-procedural diameter stenosis. Conclusions: The prognosis of patients with acute and chronic coronary syndrome in the annual follow-up is comparable in the context of cardiovascular events. The clinical presentation of ACS is an independent risk factor for all-cause death.

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