title: Predictors of cardiovascular prognosis in patients receiving optimized secondary prevention measures after acute coronary syndrome.
abstract: BACKGROUND
  After an acute coronary syndrome (ACS), optimal medical therapy (OMT) has been shown to be effective in reducing subsequent cardiovascular (CV) events. However, even in populations that reach recommended secondary prevention goals, there is a subset of patients that experience subsequent CV events.
  
  
  OBJECTIVE
  To identify biological or clinical predictors of residual risk of CV events in post-ACS patients receiving OMT.
  
  
  METHODS
  A total of 990 post-ACS patients benefited from OMT (optimized treatment during the acute and chronic post-ACS phase, along with a therapeutic and dietary education programme). Traditional CV risk factors and atheroma disease markers (intima-media thickness measurement, carotid atheroma, peripheral arterial disease (PAD) measured by ankle brachial index, and the number of coronary arteries with a >50% stenosis) were evaluated at 3 months post ACS. Cardiovascular events were recorded at follow up.
  
  
  RESULTS
  At 20-month follow up, >80% of the patients reached the recommended secondary prevention goals. In this population, diabetes was the only CV risk factor significantly associated with CV events in multivariate analysis including traditional risk factors (HR 1.61, p = 0.017). In multivariate analyses including CV risk factors and atheroma disease markers, only PAD remained significantly associated with CV events (HR 1.83, p = 0.04). The number of vascular beds involved was associated with poorer prognosis (HR for disease in 3-vascular-beds 3.85, p = 0.001, using disease in 1-vascular-bed as a reference group).
  
  
  CONCLUSIONS
  In post-ACS patients with OMT, atheroma burden is a powerful prognostic marker of recurrent CV events, while diabetes remains the only independent marker of CV events among traditional CV risk factors.
authors.affiliation: CHU de Bordeaux, Centre d'Exploration, de Prévention et de Traitement de l'Athéroclérose, Hôpital Cardiologique du Haut-Lévêque, F-33000 Bordeaux, France. marianne_lafitte@hotmail.com
authors.forename: Marianne
authors.initials: M
authors.lastname: Lafitte
authors.forename: Yann
authors.initials: Y
authors.lastname: Pucheu
authors.forename: Karin
authors.initials: K
authors.lastname: Latry
authors.forename: Marina
authors.initials: M
authors.lastname: Dijos
authors.forename: Eléonore
authors.initials: E
authors.lastname: Casassus
authors.forename: Thierry
authors.initials: T
authors.lastname: Couffinhal
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D000368:Aged; D055109:Ankle Brachial Index; D015415:Biomarkers / Q000097:blood; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D059168:Carotid Intima-Media Thickness; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D004038:Diet, Reducing; D004452:Echocardiography; D015444:Exercise; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D055414:Myocardial Perfusion Imaging; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D055502:Secondary Prevention / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D002317:Cardiovascular Agents