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Long-term outcomes and causes of death after acute coronary syndrome in patients in the Bologna, Italy, area.
Am J Cardiol. 2015 Jan 15; 115(2):171-7.AJ

Abstract

We sought to evaluate the rates, time course, and causes of death in the long-term follow-up of unselected patients with acute coronary syndromes (ACS). We enrolled 2046 consecutive patients hospitalized from January 2004 to December 2005 with an audited final diagnosis of ACS. The primary study end point was 5-year all-cause mortality. In our series, 896 patients had ST-segment elevation (STE) and 1,150 non-ST-segment elevation (NSTE). Mean age of the study population was 71.6 years. Primary percutaneous coronary intervention was performed in 86% of STE-ACS, and 70% of NSTE-ACS was managed invasively. The 5-year all-cause mortality was 36.4% for STE-ACS and 42.0% for NSTE-ACS, with patients with STE-ACS showing a trend boarding statistical significance toward a lower risk of mortality (hazard ratio [HR] = 0.88, 95% confidence interval [CI] 0.76 to 1.02, p = 0.08). Landmark analysis demonstrated that patients with STE-ACS had a higher risk of 30-day mortality (STE-ACS vs NSTE-ACS HR = 1.53, 95% CI 1.16 to 2.06, p = 0.003) whereas the risk of NSTE-ACS increased markedly after 1 year (STE-ACS vs NSTE-ACS HR = 0.67, 95% CI 0.53 to 0.84, p = 0.001). The contribution of noncardiovascular (CV) causes to overall mortality increased from 3% at 30 days to 34% at 5 years, with cancer and infections being the most common causes of non-CV death both in STE-ACS and NSTE-ACS. In conclusion, long-term mortality after ACS is still too high both for STE-ACS and NSTE-ACS. Although patients with STE-ACS have a higher mortality during the first year, the mortality of patients with NSTE-ACS increases later, when non-CV co-morbidities gain greater importance.

Authors+Show Affiliations

Istituto di Cardiologia, Università di Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy.Istituto di Cardiologia, Università di Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy.Istituto di Cardiologia, Università di Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy.Istituto di Cardiologia, Università di Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy.Istituto di Cardiologia, Università di Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy.Istituto di Cardiologia, Università di Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy.Agenzia Sanitaria Regionale, Regione Emilia Romagna, Italy.Istituto di Cardiologia, Università di Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy.Istituto di Cardiologia, Università di Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy.Istituto di Cardiologia, Università di Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy.Istituto di Cardiologia, Università di Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy.Istituto di Cardiologia, Università di Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy.Duke Clinical Research Institute, Durham, North Carolina.Agenzia Sanitaria Regionale, Regione Emilia Romagna, Italy.Istituto di Cardiologia, Università di Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy. Electronic address: claudio.rapezzi@unibo.it.Istituto di Cardiologia, Università di Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25465930

Citation

Vagnarelli, Fabio, et al. "Long-term Outcomes and Causes of Death After Acute Coronary Syndrome in Patients in the Bologna, Italy, Area." The American Journal of Cardiology, vol. 115, no. 2, 2015, pp. 171-7.
Vagnarelli F, Taglieri N, Ortolani P, et al. Long-term outcomes and causes of death after acute coronary syndrome in patients in the Bologna, Italy, area. Am J Cardiol. 2015;115(2):171-7.
Vagnarelli, F., Taglieri, N., Ortolani, P., Norscini, G., Cinti, L., Bacchi Reggiani, M. L., Marino, M., Lorenzini, M., Bugani, G., Corsini, A., Semprini, F., Nanni, S., Tricoci, P., De Palma, R., Rapezzi, C., & Melandri, G. (2015). Long-term outcomes and causes of death after acute coronary syndrome in patients in the Bologna, Italy, area. The American Journal of Cardiology, 115(2), 171-7. https://doi.org/10.1016/j.amjcard.2014.10.019
Vagnarelli F, et al. Long-term Outcomes and Causes of Death After Acute Coronary Syndrome in Patients in the Bologna, Italy, Area. Am J Cardiol. 2015 Jan 15;115(2):171-7. PubMed PMID: 25465930.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term outcomes and causes of death after acute coronary syndrome in patients in the Bologna, Italy, area. AU - Vagnarelli,Fabio, AU - Taglieri,Nevio, AU - Ortolani,Paolo, AU - Norscini,Giulia, AU - Cinti,Laura, AU - Bacchi Reggiani,Maria Letizia, AU - Marino,Massimiliano, AU - Lorenzini,Massimiliano, AU - Bugani,Giulia, AU - Corsini,Anna, AU - Semprini,Franco, AU - Nanni,Samuele, AU - Tricoci,Pierluigi, AU - De Palma,Rossana, AU - Rapezzi,Claudio, AU - Melandri,Giovanni, Y1 - 2014/10/29/ PY - 2014/07/31/received PY - 2014/10/23/revised PY - 2014/10/23/accepted PY - 2014/12/4/entrez PY - 2014/12/4/pubmed PY - 2015/3/4/medline SP - 171 EP - 7 JF - The American journal of cardiology JO - Am. J. Cardiol. VL - 115 IS - 2 N2 - We sought to evaluate the rates, time course, and causes of death in the long-term follow-up of unselected patients with acute coronary syndromes (ACS). We enrolled 2046 consecutive patients hospitalized from January 2004 to December 2005 with an audited final diagnosis of ACS. The primary study end point was 5-year all-cause mortality. In our series, 896 patients had ST-segment elevation (STE) and 1,150 non-ST-segment elevation (NSTE). Mean age of the study population was 71.6 years. Primary percutaneous coronary intervention was performed in 86% of STE-ACS, and 70% of NSTE-ACS was managed invasively. The 5-year all-cause mortality was 36.4% for STE-ACS and 42.0% for NSTE-ACS, with patients with STE-ACS showing a trend boarding statistical significance toward a lower risk of mortality (hazard ratio [HR] = 0.88, 95% confidence interval [CI] 0.76 to 1.02, p = 0.08). Landmark analysis demonstrated that patients with STE-ACS had a higher risk of 30-day mortality (STE-ACS vs NSTE-ACS HR = 1.53, 95% CI 1.16 to 2.06, p = 0.003) whereas the risk of NSTE-ACS increased markedly after 1 year (STE-ACS vs NSTE-ACS HR = 0.67, 95% CI 0.53 to 0.84, p = 0.001). The contribution of noncardiovascular (CV) causes to overall mortality increased from 3% at 30 days to 34% at 5 years, with cancer and infections being the most common causes of non-CV death both in STE-ACS and NSTE-ACS. In conclusion, long-term mortality after ACS is still too high both for STE-ACS and NSTE-ACS. Although patients with STE-ACS have a higher mortality during the first year, the mortality of patients with NSTE-ACS increases later, when non-CV co-morbidities gain greater importance. SN - 1879-1913 UR - https://www.unboundmedicine.com/medline/citation/25465930/Long_term_outcomes_and_causes_of_death_after_acute_coronary_syndrome_in_patients_in_the_Bologna_Italy_area_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9149(14)02007-4 DB - PRIME DP - Unbound Medicine ER -