Comparison of clinical profiles and care for patients with incident versus recurrent acute coronary syndromes in France: Data from the MONICA registries

Abstract

Background Recurrence is common after an acute coronary syndrome (ACS). In order to better assess the prognosis for patients with ACS, we compared clinical profiles, treatments, and case fatality rates for incident vs. recurrent ACS. Methods We enrolled 1,459 men and women (age: 35–74) living in three geographical areas covered by French MONICA registries and who had been admitted to hospital for an ACS in 2015/2016. We recorded and compared the clinical characteristics and medical care for patients with an incident vs. a recurrent ACS. Results Overall, 431 (30%) had a recurrent ACS. Relative to patients with an incident ACS, patients with recurrence were older (p<0.0001), had a greater frequency of NSTEMI or UA (p<0.0001), were less likely to show typical symptoms (p = 0.045), were more likely to have an altered LVEF (p<0.0001) and co-morbidities. Angioplasty was less frequently performed among patients with recurrent than incident NSTEMI (p<0.05). There were no intergroup differences in the prescription of the recommended secondary prevention measures upon hospital discharge, except for functional rehabilitation more frequently prescribed among incident patients (p<0.0001). Although the crude 1-year mortality rate was higher for recurrent cases (14%) than for incident cases (8%) (p<0.05), this difference was no longer significant after adjustment for age, sex, region, diagnosis category and LVEF. Conclusion Compared with incident patients, recurrent cases were more likely to have co-morbidities and to have suboptimal treatments prior to hospital stay, reinforcing the need for secondary prevention.

Incidence and predictors of recurrent acute coronary syndrome among adult patients with acute coronary syndrome in West Amhara, Ethiopia: a multicenter retrospective follow-up study

“…However, our results were lower than the 30% Re-ACS found in the French study ( 25 ). This previous study was conducted on an adult population aged 35–74 years, excluding individuals between the ages of 18 and 35 years.…”

“…However, MI that occurs within 28 days of the initial MI event is classified as a case of re-infarction ( 24 ). In this study, recurrent ACS refers to any acute coronary event that occurs after 28 days following the initial incident of ACS ( 25 ). Primary ACS is used to describe ACS that is diagnosed for the first time during the study period.…”

Challenges and Burdens in the Coronary Artery Disease Care Pathway for Patients Undergoing Percutaneous Coronary Intervention: A Contemporary Narrative Review

“…Relatedly, approximately 15-30% of patients presenting with their first myocardial infarction will be rehospitalized for recurrent cardiac events [103][104][105][106]. Patients hospitalized for recurrent ACS typically have a higher prevalence of diabetes, hyperlipidemia, hypertension, and vascular disease compared to patients experiencing only an incident event [107].…”

“…Patients hospitalized for recurrent ACS typically have a higher prevalence of diabetes, hyperlipidemia, hypertension, and vascular disease compared to patients experiencing only an incident event [107]. They also more often suffer from suboptimal treatment before index hospital admission [106]. Data from the French MONICA population-based registries showed that mortality rates at 28 days (9% vs. 5%, respectively) and one year were higher among recurrent versus incident cases (14% vs. 8%, respectively), independent of age and sex.…”

“…Data from the French MONICA population-based registries showed that mortality rates at 28 days (9% vs. 5%, respectively) and one year were higher among recurrent versus incident cases (14% vs. 8%, respectively), independent of age and sex. The higher one-year mortality rate observed among recurrent cases was explained by older age, comorbidities, and worse cardiac function, emphasizing the need to reinforce secondary prevention after an ACS and thus optimize persistent risk factors [106] and patient compliance. In a report from the TRACE-CORE study, persons with recurrent ACS were more likely to report anxiety, depression, stress, and lower mental and physical quality of life.…”