title: Clinical indicators for recurrent cardiovascular events in acute coronary syndrome patients treated with statins under routine practice in Thailand: an observational study.
abstract: BACKGROUND
  Acute coronary syndrome (ACS) patients are at very high cardiovascular risk and tend to have recurrent cardiovascular events. The clinical indicators for subsequent cardiovascular events are limited and need further investigation. This study aimed to explore clinical indicators that were associated with recurrent cardiovascular events following index hospitalization.
  
  
  METHODS
  The data of patients hospitalized with ACS at a tertiary care hospital in northern Thailand between January 2009 and December 2012 were retrospectively reviewed from medical charts and the electronic hospital database. The patients were classified into three groups based on the frequency of recurrent cardiovascular events (nonfatal ACS, nonfatal stroke, or all-cause death) they suffered: no recurrent events (0), single recurrent event (1), and multiple recurrent events (≥2). Ordinal logistic regression was performed to explore the clinical indicators for recurrent cardiovascular events.
  
  
  RESULTS
  A total of 405 patients were included; 60 % were male; the average age was 64.9 ± 11.5 years; 40 % underwent coronary revascularization during admission. Overall, 359 (88.6 %) had no recurrent events, 36 (8.9 %) had a single recurrent event, and 10 (2.5 %) had multiple recurrent events. The significant clinical indicators associated with recurrent cardiovascular events were achieving an LDL-C goal of < 70 mg/dL (Adjusted OR = 0.43; 95 % CI = 0.27-0.69, p-value < 0.001), undergoing revascularization during admission (Adjusted OR = 0.44; 95 % CI = 0.24-0.81, p-value = 0.009), being male (Adjusted OR = 1.85; 95 % CI = 1.29-2.66, p-value = 0.001), and decrease estimated glomerular filtration rate (Adjusted OR = 2.46; 95 % CI = 2.21-2.75, p-value < 0.001).
  
  
  CONCLUSIONS
  The routine clinical practice indicators assessed in ACS patients that were associated with recurrent cardiovascular events were that achieving the LDL-C goal and revascularization are protective factors, while being male and having decreased estimated glomerular filtration rate are risk factors for recurrent cardiovascular events. These clinical indicators should be used for routinely monitoring patients to prevent recurrent cardiovascular events in ACS patients.
authors.affiliation: Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand. dujrudee.c@cmu.ac.th.|Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. dujrudee.c@cmu.ac.th.
authors.forename: Dujrudee
authors.initials: D
authors.lastname: Chinwong
authors.affiliation: Center of Excellence in Applied Epidemiology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand. jpatumanond@gmail.com.
authors.forename: Jayanton
authors.initials: J
authors.lastname: Patumanond
authors.affiliation: Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand. surarong@gmail.com.
authors.forename: Surarong
authors.initials: S
authors.lastname: Chinwong
authors.affiliation: Division of Medicine, Nakornping Hospital, Chiang Mai, Thailand. kancsiri@gmail.com.
authors.forename: Khanchai
authors.initials: K
authors.lastname: Siriwattana
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand, 50200. sgunaparn@gmail.com.
authors.forename: Siriluck
authors.initials: S
authors.lastname: Gunaparn
authors.affiliation: Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, NSW, Australia. john.hall@newcastle.edu.au.
authors.forename: John Joseph
authors.initials: JJ
authors.lastname: Hall
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand, 50200. arintayap@gmail.com.
authors.forename: Arintaya
authors.initials: A
authors.lastname: Phrommintikul
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality / Q000517:prevention & control* / Q000601:surgery; D000368:Aged; D000789:Angina, Unstable / Q000401:mortality / Q000517:prevention & control* / Q000601:surgery; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control* / Q000601:surgery; D009204:Myocardial Revascularization; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D020521:Stroke / Q000401:mortality / Q000517:prevention & control*; D062606:Tertiary Care Centers; D013785:Thailand
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors