• Myocardial Infarction

Long-term cardiovascular (CV) morbidity and mortality rates are just as high for patients with non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina (UA) as for patients with STEMI, according to a long-term analysis of data from the Global Registry of Acute Coronary Events (GRACE).

The late consequences of NSTEMI and UA are poorly recognized and often underestimated, according to Keith Fox, MD, University of Edinburgh, Scotland, who presented long-term findings from the GRACE study (published simultaneously online in the European Heart Journal).

In the long-term GRACE analysis, Prof. Fox and colleagues sought to evaluate the late clinical outcomes following STEMI, NSTEMI, and UA and to determine whether the GRACE risk score predicts long-term risk of all-cause mortality, CV death, and MI among patients with acute coronary syndrome (ACS). In total, 3721 patients from GRACE registry centers in the UK and Belgium were included in the long-term study.

After 5 years, a similar proportion of patients in each ACS category had died, including 19% of STEMI patients, 22% of NSTEMI patients, and 17% of UA patients. The majority of these deaths occurred after initial hospital discharge, regardless of index event. In STEMI patients, 66% of all deaths up to 5 years occurred after hospital discharge. By comparison, 86% of NSTEMI deaths and 97% of UA deaths up to 5 years occurred after hospital discharge in the GRACE cohort. Although rates of in-hospital mortality and MI were higher following STEMI, the cumulative rates of death were not different over the duration of follow-up in the STEMI (22%) and NSTEMI/UA groups (26%; p=0.21).

Despite high rates of CV medication use during the index hospitalization and 6 months following discharge, long-term CV morbidity was also high. Across all ACS groups, many patients experienced one or more late complications, including MI (12.7%), stroke (7.7%), revascularization (16.7%), or hospital readmission for suspected ACS (53.6%).

The GRACE risk score accurately predicted long-term outcomes in patients with STEMI, NSTEMI, and UA. Relative to low-risk patients, the risk of death was 2-fold higher in the intermediate-risk group (HR, 2.14; p<0.0001) and 6-fold higher in the high-risk group (HR, 6.36; p<0.0001). When examined according to index ACS event, baseline GRACE risk scores were highly predictive of in-hospital mortality, 5-year mortality, and the combined endpoint of CV death and MI in both the STEMI and NSTEMI/UA groups (p<0.0001 for all comparisons).

By accurately predicting long-term outcomes, the GRACE risk score can be used to identify which ACS patients are most likely to benefit from aggressive secondary prevention, Prof. Fox concluded.

• © 2010 MD Conference Express