The Risk of Cardiovascular Events After an Acute Coronary Event Remains High, Especially During the First Year, Despite Revascularization.
OBJECTIVE
There is little information on the incidence and predictors of infarction, stroke, or cardiovascular death after acute coronary syndrome. We investigated these aspects and developed tools for predicting these events according to the time of their occurrence.


METHODS
A retrospective study was conducted of 4858 patients who survived an acute coronary event. We analyzed the incidence and predictors of acute myocardial infarction, stroke, or cardiovascular death during the first year (n=4858) vs successive years (n=4345 patients free of composite events during the first year).


RESULTS
There were 329 events in the first year (cumulative incidence function: 7.3% person-years) and 616 in successive years (21.5% person-years; follow-up 4.9±2.4 years). The risk of events during the first year per tertile was 2.5% person-years in the low-risk tertile (< 3 points), 4.8% person-years in the intermediate-risk tertile (3-6 points), and 15.5% person-years in the high-risk tertile (> 6 points) (P<.001). The risk of events in the cohort that had a combined event in successive years increased from 10.7% person-years in the low-risk tertile (< 3 points) to 40.3% person-years in the high-risk tertile (> 6 points) (P<.001). The 2 scales showed the following predictive indexes: C statistic, 0.74 and 0.69, respectively; P (Hosmer-Lemeshow test)≥0.44 CONCLUSION: The risk of recurrence of cardiovascular events remains high after acute coronary syndrome. The level of risk can be easily quantified with acceptable predictive ability.
Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain. Electronic address: eabuassi@yahoo.es.
Emad
E
Abu-Assi
Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
Andrea
A
López-López
Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
Violeta
V
González-Salvado
Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
Alfredo
A
Redondo-Diéguez
Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
Carlos
C
Peña-Gil
Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
Noelia
N
Bouzas-Cruz
Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
Sergio
S
Raposeiras-Roubín
Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
Rami
R
Riziq-Yousef Abumuaileq
Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
José M
JM
García-Acuña
Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
José R
JR
González-Juanatey
D054058:Acute Coronary Syndrome / Q000150:complications* / Q000601:surgery; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D009204:Myocardial Revascularization; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
Acute myocardial infarction; Escala; Incidence; Incidencia; Infarto agudo de miocardio; Predictores; Predictors; Prognosis; Pronóstico; Scale