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Open Access 01-12-2015 | Research article

Clinical indicators for recurrent cardiovascular events in acute coronary syndrome patients treated with statins under routine practice in Thailand: an observational study

Authors: Dujrudee Chinwong, Jayanton Patumanond, Surarong Chinwong, Khanchai Siriwattana, Siriluck Gunaparn, John Joseph Hall, Arintaya Phrommintikul

Published in: BMC Cardiovascular Disorders | Issue 1/2015

Abstract

Background

Acute coronary syndrome (ACS) patients are at very high cardiovascular risk and tend to have recurrent cardiovascular events. The clinical indicators for subsequent cardiovascular events are limited and need further investigation. This study aimed to explore clinical indicators that were associated with recurrent cardiovascular events following index hospitalization.

Methods

The data of patients hospitalized with ACS at a tertiary care hospital in northern Thailand between January 2009 and December 2012 were retrospectively reviewed from medical charts and the electronic hospital database. The patients were classified into three groups based on the frequency of recurrent cardiovascular events (nonfatal ACS, nonfatal stroke, or all-cause death) they suffered: no recurrent events (0), single recurrent event (1), and multiple recurrent events (≥2). Ordinal logistic regression was performed to explore the clinical indicators for recurrent cardiovascular events.

Results

A total of 405 patients were included; 60 % were male; the average age was 64.9 ± 11.5 years; 40 % underwent coronary revascularization during admission. Overall, 359 (88.6 %) had no recurrent events, 36 (8.9 %) had a single recurrent event, and 10 (2.5 %) had multiple recurrent events. The significant clinical indicators associated with recurrent cardiovascular events were achieving an LDL-C goal of < 70 mg/dL (Adjusted OR = 0.43; 95 % CI = 0.27–0.69, p-value < 0.001), undergoing revascularization during admission (Adjusted OR = 0.44; 95 % CI = 0.24–0.81, p-value = 0.009), being male (Adjusted OR = 1.85; 95 % CI = 1.29–2.66, p-value = 0.001), and decrease estimated glomerular filtration rate (Adjusted OR = 2.46; 95 % CI = 2.21–2.75, p-value < 0.001).

Conclusion

The routine clinical practice indicators assessed in ACS patients that were associated with recurrent cardiovascular events were that achieving the LDL-C goal and revascularization are protective factors, while being male and having decreased estimated glomerular filtration rate are risk factors for recurrent cardiovascular events. These clinical indicators should be used for routinely monitoring patients to prevent recurrent cardiovascular events in ACS patients.

Hamm CW, Bassand JP, Agewall S, Bax J, Boersma E, Bueno H, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2011;32(23):2999–3054.CrossRefPubMed

Granger CB, Goldberg RJ, Dabbous O, Pieper KS, Eagle KA, Cannon CP, et al. Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med. 2003;163(19):2345–53.CrossRefPubMed

Srimahachota S, Kanjanavanit R, Boonyaratavej S, Boonsom W, Veerakul G, Tresukosol D. Demographic, management practices and in-hospital outcomes of Thai Acute Coronary Syndrome Registry (TACSR): the difference from the Western world. J Med Assoc Thai. 2007;90 Suppl 1:1–11.PubMed

Srimahachota S, Boonyaratavej S, Kanjanavanit R, Sritara P, Krittayaphong R, Kunjara-Na-ayudhya R, et al. Thai Registry in Acute Coronary Syndrome (TRACS)–an extension of Thai Acute Coronary Syndrome registry (TACS) group: lower in-hospital but still high mortality at one-year. J Med Assoc Thai. 2012;95(4):508–18.PubMed

Pocock S, Bueno H, Licour M, Medina J, Zhang L, Annemans L, Danchin N, Huo Y, Van de Werf F. Predictors of one-year mortality at hospital discharge after acute coronary syndromes: A new risk score from the EPICOR (long-tErm follow uP of antithrombotic management patterns In acute CORonary syndrome patients) study. Eur Heart J Acute Cardiovasc Care. 2014.Epub ahead of print.

Murphy SA, Antman EM, Wiviott SD, Weerakkody G, Morocutti G, Huber K, et al. Reduction in recurrent cardiovascular events with prasugrel compared with clopidogrel in patients with acute coronary syndromes from the TRITON-TIMI 38 trial. Eur Heart J. 2008;29(20):2473–9.CrossRefPubMedPubMedCentral

Murphy SA, Cannon CP, Wiviott SD, McCabe CH, Braunwald E. Reduction in recurrent cardiovascular events with intensive lipid-lowering statin therapy compared with moderate lipid-lowering statin therapy after acute coronary syndromes from the PROVE IT-TIMI 22 (Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis In Myocardial Infarction 22) trial. J Am Coll Cardiol. 2009;54(25):2358–62.CrossRefPubMed

Cannon CP, Braunwald E, McCabe CH, Rader DJ, Rouleau JL, Belder R, et al. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med. 2004;350(15):1495–504.CrossRefPubMed

de Lemos JA, Blazing MA, Wiviott SD, Lewis EF, Fox KA, White HD, et al. Early intensive vs a delayed conservative simvastatin strategy in patients with acute coronary syndromes: phase Z of the A to Z trial. JAMA. 2004;292(11):1307–16.CrossRefPubMed

10.

Kaplan RC, Heckbert SR, Furberg CD, Psaty BM. Predictors of subsequent coronary events, stroke, and death among survivors of first hospitalized myocardial infarction. J Clin Epidemiol. 2002;55(7):654–64.CrossRefPubMed

11.

Maharaj Nakorn Chiang Mai Hospital [http://www.med.cmu.ac.th/2013/academic-departments-2/maharaj-nakorn-chiang-mai-hospital.html] Accessed 10 Feb 2015.

12.

Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro 3rd AF, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604–12.CrossRefPubMedPubMedCentral

13.

Reiner Z, Catapano AL, De Backer G, Graham I, Taskinen MR, Wiklund O, et al. ESC/EAS Guidelines for the management of dyslipidaemias: the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Eur Heart J. 2011;32(14):1769–818.CrossRefPubMed

14.

Armstrong BG, Sloan M. Ordinal regression models for epidemiologic data. Am J Epidemiol. 1989;129(1):191–204.PubMed

15.

Ananth CV, Kleinbaum DG. Regression models for ordinal responses: a review of methods and applications. Int J Epidemiol. 1997;26(6):1323–33.CrossRefPubMed

16.

LaRosa JC, Grundy SM, Kastelein JJ, Kostis JB, Greten H. Safety and efficacy of Atorvastatin-induced very low-density lipoprotein cholesterol levels in Patients with coronary heart disease (a post hoc analysis of the treating to new targets [TNT] study). Am J Cardiol. 2007;100(5):747–52.CrossRefPubMed

17.

Wiviott SD, Cannon CP, Morrow DA, Ray KK, Pfeffer MA, Braunwald E. Can low-density lipoprotein be too low? The safety and efficacy of achieving very low low-density lipoprotein with intensive statin therapy: A PROVE IT-TIMI 22 Substudy. J Am Coll Cardiol. 2005;46(8):1411–6.CrossRefPubMed

18.

Ray KK, Bach RG, Cannon CP, Cairns R, Kirtane AJ, Wiviott SD, et al. Benefits of achieving the NCEP optional LDL-C goal among elderly patients with ACS. Eur Heart J. 2006;27(19):2310–6.CrossRefPubMed

19.

Chinwong D, Patumanond J, Chinwong S, Siriwattana K, Gunaparn S, Hall JJ, Phrommintikul A. Low-density lipoprotein cholesterol of less than 70 mg/dL is associated with fewer cardiovascular events in acute coronary syndrome patients: a real life cohort in Thailand. Ther Clin Risk Manag. Ther Clin Risk Manag. 2015; 11:659-67.

20.

Cannon CP, Giugliano RP, Blazing MA, Harrington RA, Peterson JL, Sisk CM, et al. Rationale and design of IMPROVE-IT (IMProved Reduction of Outcomes: Vytorin Efficacy International Trial): comparison of ezetimbe/simvastatin versus simvastatin monotherapy on cardiovascular outcomes in patients with acute coronary syndromes. Am Heart J. 2008;156(5):826–32.CrossRefPubMed

21.

Blazing MA, Giugliano RP, Cannon CP, Musliner TA, Tershakovec AM, White JA, et al. Evaluating cardiovascular event reduction with ezetimibe as an adjunct to simvastatin in 18,144 patients after acute coronary syndromes: final baseline characteristics of the IMPROVE-IT study population. Am Heart J. 2014;168(2):205–12. e201.CrossRefPubMed

22.

O’Riordan, M. IMPROVE-IT: ‘Modest’ Benefit When Adding Ezetimibe to Statins in Post-ACS Patients [Available from: http://www.medscape.com/viewarticle/835030] Accessed 19 Nov 2014

23.

Jacobson TA, Ito MK, Maki KC, Orringer CE, Bays HE, Jones PH, et al. National Lipid Association recommendations for patient-centered management of dyslipidemia: Part 1 - executive summary. J Clin Lipidol. 2014;8(5):473–88.CrossRefPubMed

24.

Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25 Pt B):2889–934.CrossRefPubMed

25.

National Institute for Health and Care Excellence. Lipid Modification: Cardiovascular Risk Assessment and the Modification of Blood Lipids for the Primary and Secondary Prevention of Cardiovascular Disease. London: National Clinical Guideline Centre; 2014.

26.

Held C, Tornvall P, Stenestrand U. Effects of revascularization within 14 days of hospital admission due to acute coronary syndrome on 1-year mortality in patients with previous coronary artery bypass graft surgery. Eur Heart J. 2007;28(3):316–25.CrossRefPubMed

27.

Yan AT, Yan RT, Tan M, Eagle KA, Granger CB, Dabbous OH, et al. In-hospital revascularization and one-year outcome of acute coronary syndrome patients stratified by the GRACE risk score. Am J Cardiol. 2005;96(7):913–6.CrossRefPubMed

28.

Cannon CP, Weintraub WS, Demopoulos LA, Vicari R, Frey MJ, Lakkis N, et al. Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban. N Engl J Med. 2001;344(25):1879–87.CrossRefPubMed

29.

Invasive compared with non-invasive treatment in unstable coronary-artery disease: FRISC II prospective randomised multicentre study. FRagmin and Fast Revascularisation during InStability in Coronary artery disease Investigators. Lancet 1999, 354(9180):708–715.

30.

Fox KA, Poole-Wilson PA, Henderson RA, Clayton TC, Chamberlain DA, Shaw TR, et al. Interventional versus conservative treatment for patients with unstable angina or non-ST-elevation myocardial infarction: the British Heart Foundation RITA 3 randomised trial. Randomized Intervention Trial of unstable Angina. Lancet. 2002;360(9335):743–51.CrossRefPubMed

31.

Vanasse A, Courteau J, Niyonsenga T. Revascularization and cardioprotective drug treatment in myocardial infarction patients: how do they impact on patients’ survival when delivered as usual care. BMC Cardiovasc Disord. 2006;6:21.CrossRefPubMedPubMedCentral

32.

Bandara R, Medagama A, Munasinghe R, Dinamithra N, Subasinghe A, Herath J, et al. Management and outcomes of acute ST-segment-elevation myocardial infarction at a tertiary-care hospital in Sri Lanka: an observational study. BMC Cardiovasc Disord. 2015;15(1):1.CrossRefPubMedPubMedCentral

33.

D’Ascenzo F, Gonella A, Quadri G, Longo G, Biondi-Zoccai G, Moretti C, et al. Comparison of mortality rates in women versus men presenting with ST-segment elevation myocardial infarction. Am J Cardiol. 2011;107(5):651–4.CrossRefPubMed

34.

Wilson PW, D’Agostino Sr R, Bhatt DL, Eagle K, Pencina MJ, Smith SC, et al. An international model to predict recurrent cardiovascular disease. Am J Med. 2012;125(7):695–703. e691.CrossRefPubMed

35.

Movahed MR, Hashemzadeh M, Jamal MM, Ramaraj R. Decreasing in-hospital mortality of patients undergoing percutaneous coronary intervention with persistent higher mortality rates in women and minorities in the United States. J Invasive Cardiol. 2010;22(2):58–60.PubMed

36.

Singh M, Rihal CS, Gersh BJ, Roger VL, Bell MR, Lennon RJ, et al. Mortality differences between men and women after percutaneous coronary interventions. A 25-year, single-center experience. J Am Coll Cardiol. 2008;51(24):2313–20.CrossRefPubMedPubMedCentral

37.

Srichaiveth B, Ruengsakulrach P, Visudharom K, Sanguanwong S, Tangsubutr W, Insamian P. Impact of gender on treatment and clinical outcomes in acute ST elevation myocardial infarction patients in Thailand. J Med Assoc Thai. 2007;90 Suppl 1:65–73.PubMed

38.

Walsh CR, O’Donnell CJ, Camargo Jr CA, Giugliano RP, Lloyd-Jones DM. Elevated serum creatinine is associated with 1-year mortality after acute myocardial infarction. Am Heart J. 2002;144(6):1003–11.CrossRefPubMed

39.

Facila L, Nunez J, Bodi V, Sanchis J, Bertomeu-Gonzalez V, Consuegra L, et al. Prognostic value of serum creatinine in non-ST-elevation acute coronary syndrome. Rev Esp Cardiol. 2006;59(3):209–16.CrossRefPubMed

40.

Jose P, Skali H, Anavekar N, Tomson C, Krumholz HM, Rouleau JL, et al. Increase in creatinine and cardiovascular risk in patients with systolic dysfunction after myocardial infarction. J Am Soc Nephrol. 2006;17(10):2886–91.CrossRefPubMed

41.

Krumholz HM, Chen J, Chen YT, Wang Y, Radford MJ. Predicting one-year mortality among elderly survivors of hospitalization for an acute myocardial infarction: results from the Cooperative Cardiovascular Project. J Am Coll Cardiol. 2001;38(2):453–9.CrossRefPubMed

42.

Sooklim K, Srimahachota S, Boonyaratavej S, Kanjanavanit R, Siriviwattanakul N, Piamsomboon C, et al. Renal dysfunction as an independent predictor of total mortality after acute coronary syndrome: the Thai ACS Registry. J Med Assoc Thai. 2007;90 Suppl 1:32–40.PubMed

43.

Kang YU, Jeong MH, Kim SW. Impact of renal dysfunction on clinical outcomes of acute coronary syndrome. Yonsei Med J. 2009;50(4):537–45.CrossRefPubMedPubMedCentral

44.

Mielniczuk LM, Pfeffer MA, Lewis EF, Blazing MA, de Lemos JA, Shui A, et al. Estimated glomerular filtration rate, inflammation, and cardiovascular events after an acute coronary syndrome. Am Heart J. 2008;155(4):725–31.CrossRefPubMed

45.

Anavekar NS, McMurray JJ, Velazquez EJ, Solomon SD, Kober L, Rouleau JL, et al. Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. N Engl J Med. 2004;351(13):1285–95.CrossRefPubMed

46.

Al Suwaidi J, Reddan DN, Williams K, Pieper KS, Harrington RA, Califf RM, et al. Prognostic implications of abnormalities in renal function in patients with acute coronary syndromes. Circulation. 2002;106(8):974–80.CrossRefPubMed

47.

Wattanakit K, Folsom AR, Chambless LE, Nieto FJ. Risk factors for cardiovascular event recurrence in the Atherosclerosis Risk in Communities (ARIC) study. Am Heart J. 2005;149(4):606–12.CrossRefPubMed

48.

Brugger-Andersen T, Ponitz V, Staines H, Pritchard D, Grundt H, Nilsen DW. B-type natriuretic peptide is a long-term predictor of all-cause mortality, whereas high-sensitive C-reactive protein predicts recurrent short-term troponin T positive cardiac events in chest pain patients: a prognostic study. BMC Cardiovasc Disord. 2008;8:34.CrossRefPubMedPubMedCentral

49.

Zamani P, Schwartz GG, Olsson AG, Rifai N, Bao W, Libby P, et al. Inflammatory biomarkers, death, and recurrent nonfatal coronary events after an acute coronary syndrome in the MIRACL study. J Am Heart Assoc. 2013;2(1):e003103.CrossRefPubMedPubMedCentral

Title: Clinical indicators for recurrent cardiovascular events in acute coronary syndrome patients treated with statins under routine practice in Thailand: an observational study
Authors: Dujrudee Chinwong
Jayanton Patumanond
Surarong Chinwong
Khanchai Siriwattana
Siriluck Gunaparn
John Joseph Hall
Arintaya Phrommintikul
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: BMC Cardiovascular Disorders / Issue 1/2015
Electronic ISSN: 1471-2261
DOI: https://doi.org/10.1186/s12872-015-0052-y

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Results

Conclusion

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