Long-term Predictors of Death Among Tunisian Patients Presenting for Non ST-elevation Acute Coronary Syndrome

Overview

Journal Tunis Med

Specialty General Medicine

Date 2022 Mar 9

PMID 35261006

Authors

Walid Jomaa

Ouday Benabdeljelil

Ikram Chamtouri

Wajih Abdallah

Khaldoun Ben Hamda

Faouzi Maatouk

Affiliations

Soon will be listed here.

Abstract

Background: Coronary artery disease is the leading cause of death in emerging countries. Contemporary data about clinical profile and prognosis in Tunisian patients presenting for non ST-elevation acute coronary syndrome (NSTE-ACS) are lacking.

Aim: We sought to study the risk profile and 3-year mortality predictors in Tunisian patients presenting for NSTE-ACS in the contemporary setting.

Methods: In this single center study, data about all consecutive patients presenting to our center for NSTE-ACS from April 2014 to July 2016 were extracted and outcomes exhaustively updated. 3-year mortality predictors were determined by multivariable survival analysis.

Results: A total of 340 patients were included, of which 204 (61.8%) were male. Mean age was 63.6 ± 10.3 years. Prevalence of diabetes mellitus, hypertension and smoking was 57.3%, 62.4%, and 45.3%, respectively. In-hospital, 6, 12 and 36-month mortality rate was 2.3%, 3.2%, 7.1% and 15.2%, respectively. In multivariable survival analysis, independent predictors of death were age >75 (HR=5.45, 95% CI: 2.9-10.03, p<0.001), ST-segment deviation (HR=1.86, 95% CI: 1.04-3.33, p=0.036), anemia (HR=2.56, 95% CI: 1.41-4.67, p=0.002), left ventricular ejection fraction (LVEF) <40% (HR=3.5, 95% CI: 1.84-6.67, p<0.001) and a Global Registry of Acute Coronary Events (GRACE) score ≥140 (HR=2.38, 95% CI: 1.02-5.57, p=0.044).

Conclusion: In Tunisian patients presenting for NSTE-ACS, long-term mortality was high. Advanced age, ST-segment deviation, anemia, LVEF <40% and a GRACE score ≥140 were independent long-term predictors of death.

References

Terkelsen C, Lassen J, Norgaard B, Gerdes J, Jensen T, Gotzsche L . Mortality rates in patients with ST-elevation vs. non-ST-elevation acute myocardial infarction: observations from an unselected cohort. Eur Heart J. 2004; 26(1):18-26. DOI: 10.1093/eurheartj/ehi002. View

Roth G, Johnson C, Abajobir A, Abd-Allah F, Abera S, Abyu G . Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015. J Am Coll Cardiol. 2017; 70(1):1-25. PMC: 5491406. DOI: 10.1016/j.jacc.2017.04.052. View

Zubaid M, Rashed W, Al-Khaja N, Almahmeed W, Al-Lawati J, Sulaiman K . Clinical presentation and outcomes of acute coronary syndromes in the gulf registry of acute coronary events (Gulf RACE). Saudi Med J. 2008; 29(2):251-5. View

Vedanthan R, Seligman B, Fuster V . Global perspective on acute coronary syndrome: a burden on the young and poor. Circ Res. 2014; 114(12):1959-75. PMC: 4144436. DOI: 10.1161/CIRCRESAHA.114.302782. View

Henderson R, Jarvis C, Clayton T, Pocock S, Fox K . 10-Year Mortality Outcome of a Routine Invasive Strategy Versus a Selective Invasive Strategy in Non-ST-Segment Elevation Acute Coronary Syndrome: The British Heart Foundation RITA-3 Randomized Trial. J Am Coll Cardiol. 2015; 66(5):511-20. DOI: 10.1016/j.jacc.2015.05.051. View

Jomaa W, Ali I, Hamdi S, Azaiez M, El Hraiech A, Ben Hamda K . Prevalence and prognostic significance of anemia in patients presenting for ST-elevation myocardial infarction in a Tunisian center. J Saudi Heart Assoc. 2017; 29(3):153-159. PMC: 5475353. DOI: 10.1016/j.jsha.2016.10.003. View

Levey A, Bosch J, Lewis J, Greene T, Rogers N, Roth D . A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999; 130(6):461-70. DOI: 10.7326/0003-4819-130-6-199903160-00002. View

Addad F, Gouider J, Boughzela E, Kamoun S, Boujenah R, Haouala H . [Management of patients treated for acute ST-elevation myocardial infarction in Tunisia: Preliminary results of FAST-MI Tunisia Registry from Tunisian Society of Cardiology and Cardiovascular Surgery]. Ann Cardiol Angeiol (Paris). 2015; 64(6):439-45. DOI: 10.1016/j.ancard.2015.09.064. View

Alhabib K, Sulaiman K, Al-Motarreb A, Almahmeed W, Asaad N, Amin H . Baseline characteristics, management practices, and long-term outcomes of Middle Eastern patients in the Second Gulf Registry of Acute Coronary Events (Gulf RACE-2). Ann Saudi Med. 2011; 32(1):9-18. PMC: 6087639. DOI: 10.5144/0256-4947.2012.9. View

10.

Hamm C, Bassand J, Agewall S, Bax J, Boersma E, Bueno H . ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment.... Eur Heart J. 2011; 32(23):2999-3054. DOI: 10.1093/eurheartj/ehr236. View

11.

Goodman S, Huang W, Yan A, Budaj A, Kennelly B, Gore J . The expanded Global Registry of Acute Coronary Events: baseline characteristics, management practices, and hospital outcomes of patients with acute coronary syndromes. Am Heart J. 2009; 158(2):193-201.e1-5. DOI: 10.1016/j.ahj.2009.06.003. View

12.

Tan Y, Sinclair H, Ghoorah K, Teoh X, Mehran R, Kunadian V . Gender differences in outcomes in patients with acute coronary syndrome in the current era: A review. Eur Heart J Acute Cardiovasc Care. 2015; 5(7):51-60. DOI: 10.1177/2048872615610886. View

13.

Fox K, Dabbous O, Goldberg R, Pieper K, Eagle K, Van de Werf F . Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ. 2006; 333(7578):1091. PMC: 1661748. DOI: 10.1136/bmj.38985.646481.55. View

14.

Jomaa W, Hamdi S, Ali I, Azaiez M, El Hraiech A, Ben Hamda K . Risk profile and in-hospital prognosis in elderly patients presenting for acute ST-elevation myocardial infarction in the Tunisian context. Indian Heart J. 2016; 68(6):760-765. PMC: 5143825. DOI: 10.1016/j.ihj.2016.01.020. View

15.

Neumann F, Sousa-Uva M . 'Ten commandments' for the 2018 ESC/EACTS Guidelines on Myocardial Revascularization. Eur Heart J. 2019; 40(2):79-80. DOI: 10.1093/eurheartj/ehy855. View

16.

Torre L, Bray F, Siegel R, Ferlay J, Lortet-Tieulent J, Jemal A . Global cancer statistics, 2012. CA Cancer J Clin. 2015; 65(2):87-108. DOI: 10.3322/caac.21262. View

17.

Kechida M . Cardio-metabolic risk factors in Tunisia: state of the art. Intern Emerg Med. 2019; 15(4):537-542. DOI: 10.1007/s11739-019-02164-7. View

18.

Viana-Tejedor A, Loughlin G, Fernandez-Aviles F, Bueno H . Temporal trends in the use of reperfusion therapy and outcomes in elderly patients with first ST elevation myocardial infarction. Eur Heart J Acute Cardiovasc Care. 2015; 4(5):461-7. DOI: 10.1177/2048872614565928. View

19.

Mamas M, Kwok C, Kontopantelis E, Fryer A, Buchan I, Bachmann M . Relationship Between Anemia and Mortality Outcomes in a National Acute Coronary Syndrome Cohort: Insights From the UK Myocardial Ischemia National Audit Project Registry. J Am Heart Assoc. 2016; 5(11). PMC: 5210321. DOI: 10.1161/JAHA.116.003348. View

20.

Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V . Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012; 380(9859):2095-128. PMC: 10790329. DOI: 10.1016/S0140-6736(12)61728-0. View