Background. Risk stratification in patients discharged from hospital after coronary syndrome (ACS) play a central role in the management the patients during follow-up. The aim of study was to evaluate the clinical predictors of one-year mortality after ACS.
Methods. We analysed data from 2011 participants of Apulia Ponte ACS who were on one-year follow-up. The APULIA PONTE ACS (PDTA per il follow-up integrato ospedale-territorio del paziente dopo SCA e/o rivascolarizzazione miocardica) Project had been created in order to guarantee a dedicated outpatient follow-up in patients who underwent coronary revascularization and/or ACS by creating a dedicated network among Hub/Spoke centers, outpatient clinics, local cardiologists, general practitioners, and home management of the disease. The primary endpoint was all-cause mortality. We used Cox proportional hazards regression analysis to identified prognostic markers and ROC curve analysis to assess their optimal cut-offs.
Results. At 1-year follow-up, death occurred in 61 patients (3.0 %). The mortality was significantly higher in patients with non-STE-ACS asn compared to patients with STE-ACS (3.0% vs 1.9%, p<0.04). Age, heat rate, systolic blood pressure and left ventricular function remained independent predictor of mortality, while ACS type was no longer associated with death. The optimal cut-offs for death occurrence were age >73 years, heart rate >67 bpm, systolic blood pressure <120 mmHg, and left ventricular ejection fraction <40%. When a score based on the number of these prognostic variables was used (range 0-4), it was significantly associated with mortality (HR 3.1, 95% CI 2.5-3.9, p<0.0001, and area under the ROC curve = 0.81, p<0.0001). A score >1 showed a predictive positive value = 8% and predictive negative value = 99%.
Conclusions. Age, heart rate, systolic blood pressure, left ventricular function at discharge after ACS provide independent and complementary prognostic information independent from ACS type. Our results suggest that the combination of four clinical variables can provide an easy prognostic approach in patients with ASC after hospital discharge potentially useful for personalized care.