Two-year outcomes post-discharge in Asian patients with acute coronary syndrome: Findings from the EPICOR Asia study. (15th September 2020)

• Record Type: Journal Article
• Authors: Huo, Yong; Lee, Stephen W.-L.; Sawhney, Jitendra P.S.; Kim, Hyo-Soo; Krittayaphong, Rungroj; Pocock, Stuart J.; Nhan, Vo T.; Alonso-Garcia, Ángeles; Chin, Chee Tang; Jiang, Jie; Jan, Stephen; Vega, Ana M.; Hayashi, Nobuya; Ong, Tiong Kiam
• Is Part Of: International journal of cardiology. Volume 315(2020)
• Page Start: 1
• Page End: 8
• Publication Date: 2020-09-15
• Subjects: ACE angiotensin-converting enzyme -- ACS acute coronary syndrome -- AMP antithrombotic management patterns -- BMI body mass index -- CABG coronary bypass graft -- CI confidence interval -- CVD cardiovascular disease -- DAPT dual antiplatelet therapy -- eGFR estimated glomerular filtration rate -- EQ-5D EuroQol 5-Dimensions health status instrument -- EPICOR Long-tErm follow-uP of antithrombotic management patterns In Acute CORonary Syndrome patients -- Hb hemoglobin -- HK/Si/SK Hong Kong, Singapore, and South Korea -- HR hazard ratio -- ICH International Conference on Harmonization -- IS ischemic stroke -- KAMIR Korea Acute Myocardial Infarction Registry -- Ma/Th/Vie Malaysia, Thailand, and Vietnam -- MACE major adverse cardiovascular events -- MI myocardial infarction -- NSAID non-steroidal anti-inflammatory drug -- NSTEMI non-ST-segment elevation myocardial infarction -- PCI percutaneous coronary intervention -- SAPT single antiplatelet therapy -- STEMI ST-segment elevation myocardial infarction -- TIA transient ischemic attack -- UA unstable angina; Asia -- Observational -- Acute coronary syndrome -- Acute coronary care -- Antithrombotic management patterns -- Post-discharge mortality; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2020.05.022
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Aims: Approximately half of cases of cardiovascular disease (CVD) worldwide occur in Asia, with acute coronary syndrome (ACS) a leading cause of mortality. Long-term ACS-related outcomes data in Asia are limited. This analysis examined 2-year ACS-related outcomes in patients enrolled in the EPICOR Asia study, and the association between patient characteristics and management on outcomes. Methods: EPICOR Asia is a multinational, prospective, primary data collection study of real-world management of Asian patients with ACS. Overall, 12, 922 eligible adults (hospitalized for ACS within 48 h of symptom onset and who survived to discharge) were enrolled from 219 centers in eight Asian countries. Patients were followed up post-discharge for 2 years and clinical outcomes recorded. Results: Patients were of mean age 60 years and 76% were male. Diagnoses were STEMI (51.2%), NSTEMI (19.9%), and UA (28.9%). During follow-up, 5.2% of patients died; NSTEMI patients had the highest risk profile. Mortality rate (adjusted HR [95% CI]) was similar in NSTEMI (0.97 [0.81–1.17]) and lower in UA (0.52 [0.33–0.82]) vs STEMI. Similar trends (adjusted) were seen for the composite endpoint of death, myocardial infarction, or ischemic stroke, and bleeding rates did not differ significantly. For all three diagnoses, patients who were medically managed had a markedly elevated risk of both death and the composite endpoint. Conclusions: During 2-year follow-up, adjusted risks of mortality, the composite endpoint, and bleeding rates were similar in NSTEMI and STEMI patients. Outcomes risk was better for invasive management. Long-term management strategies in Asia need to be optimized. Highlights: EPICOR Asia was a prospective, real-world, 2-year follow-up study of ACS survivors. Among 12, 922 patients, diagnoses were STEMI (51.2%), NSTEMI (19.9%), and UA (28.9%). CV event rates and mortality were similar in NSTEMI and STEMI, and lower in UA. Conservatively managed patients had a markedly elevated risk of events. Long-term management strategies in Asia need to be optimized.