Secondary prevention of a Recurrent ACS; Results from the 2004 & 2006 ACSIS Survey

Perl L, Behar S, Schwartz R, Mosseri M

Meir Hospital and Sheba Tel Hashomer, Sackler Meir Hospital and Sheba Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv UniversityFaculty of Medicine, Tel Aviv University

IntroductionIntroduction The preventive effects of cardiovascular drugs

after an acute coronary syndrome (ACS) are well established, but little is known concerning the characteristics of a recurrent event, if one should occur.

We therefore studied the characteristics of an ACS in patients who present with a recurrent ACS (RACS), and the association with secondary preventive drugs.

MethodsMethodsData was collected from the 2004 and

2006 ACSIS (Acute Coronary Syndrome Israeli Survey) - a biannual survey on acute myocardial infarction performed in 26 intensive cardiac care units in Israel during a two-month period.

In the two surveys, there were 1207 RACS out of 4168 patients over all.

Secondary treatment surveyed: ACEi, beta blockers, statins, platelet inhibitors.

Data were analysed and was assessed for survival according to secondary treatment rates according to the following variables:Recurrent vs. first ACS, KILLIP and TIMI risk scores, and other variables.

Methods 2Methods 2

Patients’ CharacteristicsPatients’ Characteristics

KILLIPTIMIFACS Age

FemaleMaleGender

% of TotalNumberVariableCategory

Results (I)- Results (I)- Treatment RatesTreatment Rates

Treatment Rate

0%20%

40%60%

80%

01-23-4Num. of Drugs

Results (II)-Results (II)- Mortality according Mortality according to number of drugsto number of drugs

Mortality

0%2%4%6%8%

01-23-4Num. of Drugs

7d Mortality

30d Mortality

P=NS

Results (III)- Results (III)- 11 Year Mortality Year Mortality??????????

Results (III)Results (III) However, when corrected for TIMI scores, there However, when corrected for TIMI scores, there

is a trend towards lower mortality in the 3-4 is a trend towards lower mortality in the 3-4 drugs (OR=0.88, CI 0.49-1.61 in the high TIMI drugs (OR=0.88, CI 0.49-1.61 in the high TIMI score).score).

ConclusionsConclusionsIn general, RACS patients are under

treated with secondary preventive drugs prior to admission.

Although initial analysis revealed a trend for a higher short term mortality rate in those who were treated with more drugs, there was no change in mortality when adjusted for confounding factors.

After a year….????