Long-term cardiovascular outcomes in patients hospitalised with acute coronary syndrome subtypes in Western Australia, 2002–2019
Joseph Hung, Aaron Fudge, Derrick Lopez, Keira Robinson, Ingrid Stacey, Tom Briffa, Lee Nedkoff, Dawit ZemedikunBackground
Despite advances in acute coronary syndrome (ACS) management, contemporary data assessing long-term prognosis after ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and unstable angina (UA) are scarce.
Methods
Linked hospitalisation and mortality data identified all 30-day survivors of index STEMI, NSTEMI and UA hospitalisation in Western Australia between 2002 and 2019. We assessed the cumulative 5-year incidence of major adverse cardiovascular events (MACE), comprising non-fatal MI, stroke, heart failure hospitalisation or cardiovascular death and separately all-cause death in 30-day survivors of index ACS hospitalisation. Associations were examined using Cox proportional hazards modelling after adjustment for potential confounders.
Results
The cohort totalled 73 321 patients with ACS, 65% males, 22.3% with STEMI, 43.2% NSTEMI and 34.6% UA with mean age 63.2, 68.8 and 66.4 years, respectively. Patients with NSTEMI and UA compared with STEMI were more likely to be female with additional comorbidities. Cumulative 5-year MACE rates after NSTEMI were 29.7% vs 19.4% and 19.9% after STEMI and UA, respectively (log-rank p<0.001), while all-cause mortality was 29.8% vs 15.9% and 17.2%, respectively (log-rank p<0.001). There was no temporal improvement in multivariable-adjusted risk of outcomes for all ACS subtypes throughout the study period. The adjusted HRs for MACE and all-cause death were 1.5-fold or higher in males and females with STEMI or NSTEMI versus UA.
Conclusions
Long-term risk of MACE and all-cause death remains high and unchanged among 30-day survivors of all ACS subtypes in the recent era. Long-term surveillance and optimal secondary prevention are important in survivors of all ACS subtypes.