Demographics, practice patterns and long-term outcomes of patients with non–ST-segment elevation acute coronary syndrome in the past two decades: the CREDO-Kyoto Cohort-2 and Cohort-3

• Published in: BMJ open Vol. 11; no. 2; p. e044329
• Main Authors: Takeji, Yasuaki, Shiomi, Hiroki, Morimoto, Takeshi, Yoshikawa, Yusuke, Taniguchi, Ryoji, Mutsumura-Nakano, Yukiko, Yamamoto, Ko, Yamaji, Kyohei, Tazaki, Junichi, Suwa, Satoru, Inoko, Moriaki, Takeda, Teruki, Shirotani, Manabu, Ehara, Natsuhiko, Ishii, Katsuhisa, Inada, Tsukasa, Onodera, Tomoya, Shinoda, Eiji, Yamamoto, Takashi, Tamura, Takashi, Nakatsuma, Kenji, Sakamoto, Hiroki, Ando, Kenji, Soga, Yoshiharu, Furukawa, Yutaka, Sato, Yukihito, Nakagawa, Yoshihisa, Kadota, Kazushige, Komiya, Tatsuhiko, Minatoya, Kenji, Kimura, Takeshi
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 22.02.2021; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Acute Coronary Syndrome - surgery; Acute coronary syndromes; Anemia; Angioplasty; Biomarkers; Blood pressure; Body mass index; Cardiovascular disease; Cardiovascular Medicine; Clinical outcomes; Coronary Artery Disease - surgery; coronary heart disease; coronary intervention; Coronary vessels; Demographics; Demography; Diabetes; Drug-Eluting Stents; Heart attacks; Heart failure; Heart surgery; Hemodialysis; Humans; Hypertension; myocardial infarction; Outcome Assessment, Health Care; Percutaneous Coronary Intervention; Retrospective Studies; Risk Factors; Stents; Stroke; Thrombosis; Treatment Outcome; Variables; Japan; coronary intervention; coronary heart disease; myocardial infarction
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2020-044329

ObjectivesTo evaluate patient characteristics and long-term outcomes in patients with non–ST-segment elevation acute coronary syndrome (NSTEACS) in the past two decades.DesignMulticenter retrospective study.SettingThe Coronary REvascularization Demonstrating Outcome Study in Kyoto (CREDO-Kyoto) percutaneous coronary intervention (PCI)/coronary artery bypass grafting (CABG) Registry Cohort-2 (2005–2007) and Cohort-3 (2011–2013).Participants3254 patients with NSTEACS who underwent first coronary revascularisation.Primary and secondary outcome measuresThe primary outcome was all-cause death. The secondary outcomes were cardiovascular death, cardiac death, sudden cardiac death, non-cardiovascular death, non-cardiac death, myocardial infarction, definite stent thrombosis, stroke, hospitalisation for heart failure, major bleeding, any coronary revascularisation and target vessel revascularisation.ResultsPatients in Cohort-3 were older and more often had heart failure at admission than those in Cohort-2. The prevalence of PCI, emergency procedure and guideline-directed medical therapy was higher in Cohort-3 than in Cohort-2. In patients who received PCI, the prevalence of transradial approach, drug-eluting stent use and intravascular ultrasound use was higher in Cohort-3 than in Cohort-2. There was no change in 3-year adjusted mortality risk from Cohort-2 to Cohort-3 (HR 1.00, 95% CI 0.83 to 1.22, p=0.97). Patients in Cohort-3 compared with those in Cohort-2 were associated with lower adjusted risks for stroke (HR 0.65, 95% CI 0.46 to 0.92, p=0.02) and any coronary revascularisation (HR 0.76, 95%CI 0.66 to 0.87, p<0.001), but with higher risk for major bleeding (HR 1.25, 95% CI 1.06 to 1.47, p=0.008). The unadjusted risk for definite stent thrombosis was lower in Cohort-3 than in Cohort 2 (HR 0.29, 95% CI 0.11 to 0.67, p=0.003).ConclusionsIn the past two decades, we did not find improvement for mortality in patients with NSTEACS. We observed a reduction in the risks for definite stent thrombosis, stroke and any coronary revascularisation, but an increase in the risk for major bleeding.