Five-year outcomes in patients with non-ST-segment elevation acute coronary syndrome in the prospective CONTRAST registry

Abstract

Aim . To study 5-year outcomes in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in a prospective registry. Material and methods . The Registry of Acute Coronary Syndrome without ST-segment Elevation in the Regional Vascular Center (CONTRAST) included 136 patients admitted to the Sergiyev Posad Vascular Center from October 2018 to March 2019 with a diagnosis of NSTE-ACS. At discharge, the patients were diagnosed with unstable angina (UA) (n=112) or non-ST-segment elevation MI (NSTEMI) (n=24). Five-year outcomes were analyzed. Results . The primary composite endpoint (CEP), including all-cause death, nonfatal myocardial infarction (MI), cerebrovascular accident, and emergency hospitalizations for cardiovascular causes, was recorded in 60 patients. Patients with CEP did not differ in age, sex, or risk factors compared to patients without CEP, but they were more likely to have a history of MI, hypokinesis on echocardiography, and a mildly reduced left ventricular ejection fraction. There were no significant differences in the incidence of CEP between patients with NSTEMI and UA. Multivariate Cox regression analysis showed that independent CEP predictors included hypokinesia area on echocardiography, a moderately reduced left ventricular ejection fraction, pleural effusion in the acute phase, and atrial fibrillation. Patients with NSTEMI and UA did not differ in the likelihood of CEP. PCI during and after the reference hospitalization also did not affect the likelihood of CEP. Conclusion . In a 5-year prospective follow-up study of patients with NSTE-ACS, the likelihood of adverse outcomes was determined primarily by clinical and imaging risk factors identified in the acute phase and was independent of the formal discharge diagnosis (UA or NSTEMI).