Comparison of risk scores and sex-related outcomes in non-ST-elevation acute coronary syndrome during long term follow-up

Cilj disertacije: Cilj ovog istraživanja je usporediti različite bodovne sustave u procjeni dugoročnih neželjenih ishoda u bolesnika s akutnim koronarnim sindromom bez elevacije ST spojnice (NSTE-AKS). Dodatni cilj je istražiti razlike između spolova u obilježjima i dugoročnim neželjenim ishodima nakon NSTE-AKS. Materijali i metode: Ovo prospektivno istraživanje uključilo je 276 NSTE-AKS bolesnika podvrgnutih koronarnoj angiografiji u Kliničkom bolničkom centru Split između rujna 2012. i svibnja 2015. godine koji su liječeni svim terapijskim metodama. Izračunata je vrijednost šest bodovnih sustava: GRACE 2.0, ACEF, SYNTAX, Clinical SYNTAX, SYNTAX II PCI i SYNTAX II CABG. Primarni skupni neželjeni ishod (MACE) sastojao se od srčane smrti, nefatalnog infarkta miokarda, ishemijskog moždanog udara i žurne koronarne revaskularizacije. Rezultati: Zabilježena su ukupno 64 (23,2%) MACE-a uz medijan praćenja od 35 mjeseci. Značajni neovisni prediktor MACE-a u multivarijatnoj analizi bio je ACEF bodovni sustav (HR 2,16, 95%CI 1,36-3,44, P=0,001), a najtočniji bodovni sustavi u predikciji MACE-a bili su ACEF (AUC 0,630) i SYNTAX II PCI (AUC 0,626). Bolesnici ženskog spola bili su stariji (medijan 69 vs. 63 godine, P=0,008), ali nije bilo značajne razlike između spolova u komorbiditetima, liječenju, nalazu koronarne angiografije i otpusnoj terapiji (P>0.05). U univarijatnoj analizi značajan prediktor MACE-a bio je ženski spol (HR 1,86, 95%CI 1,12-3,09, P=0,014) uz veću kumulativnu incidenciju MACE-a (P=0.014), ali nakon prilagodbe navedene razlike u predikciji (HR 1,60, 95%CI 0,94-2,73, P=0,083) i kumulativnoj incidenciji MACE-a (P=0,177) postale su neznačajne. Zaključci: ACEF bodovni sustav pokazuje najbolju prediktivnu vrijednost u ovoj NSTE-AKS populaciji. NSTE-AKS bolesnici ženskog spola imaju lošije dugoročne ishode, ali razlike između spolova nestaju nakon prilagodbe za osnovna obilježja.Objectives: The aim of this study was to compare several established risk scores in the alltreatment cohort of non-ST-elevation acute coronary syndrome (NSTE-ACS) during long-term follow-up. Additionally, the aim was to investigate sex-based differences in characteristics and long-term outcomes after NSTE-ACS. Materials and methods: This prospective study enrolled 276 consecutive patients with NSTEACS undergoing coronary angiography at the University Hospital of Split between September 2012 and May 2015. Six risk scores were calculated: GRACE 2.0, ACEF, SYNTAX, Clinical SYNTAX, SYNTAX II PCI and SYNTAX II CABG. The primary outcome was a composite of cardiac death, nonfatal myocardial infarction, ischemic stroke and urgent revascularization (MACE). Results: A total of 64 (23.2%) MACE were recorded with a median follow-up of 35 months. Significant independent predictor for MACE in the multivariate analysis was ACEF risk score (HR 2.16, 95% CI 1.36-3.44, P=0.001), while the best discrimination for MACE showed ACEF (AUC 0.630) and SYNTAX II PCI (AUC 0.626) risk scores. Females were older (median 69 vs. 63 years, P=0.008), but there were no significant sex differences in comorbidities, treatment, coronary angiographic findings and discharge therapy (P>0.05). Significant predictor for MACE in the univariate analysis was female sex (HR 1.86, 95% CI 1.12-3.09, P=0.014) with a higher incidence of MACE (P=0.014), but after adjustment aforementioned differences in prediction (HR 1.60, 95% CI 0.94-2.73, P = 0.083) and the incidence of MACE (P=0.177) disappeared. Conclusions: The ACEF risk score demonstrates the best performance in this NSTE-ACS population. Female NSTE-ACS patients have poorer long-term outcomes, but sex differences disappear after multivariate adjustment