Arq. Bras. Cardiol. 2023; 120(5): e20220849
Prognosis Related to Reperfusion Therapy Post-Acute Coronary Syndrome in Secondary Care: Long-Term Survival Analysis in the ERICO Study
Tatiana C. Bruno
, Márcio S. Bittencourt, Alessandra V. L. Quidim, Itamar S. Santos
, Paulo A. Lotufo, Isabela M. Benseñor, Alessandra C. Goulart
This Original Article is referred by the Short Editorial "Improving Outcomes of Patients with Acute Coronary Disease in Real Life: The Case of Applying in Practice What We Already Know from Clinical Studies".
Abstract
Background
Relationship between reperfusion therapy post-acute coronary syndrome (ACS) and mortality in secondary care is not well-known.
Objectives
To evaluate the impact of three therapeutic strategies: (1) exclusive medical therapy, (2) percutaneous coronary intervention (PCI) and (3) coronary artery bypass grafting (CABG) on long-term survival of participants in the Strategy of Registry of Acute Coronary Syndrome (ERICO) study.
Methods
Survival analyses for all-cause, cardiovascular (CVD) and coronary artery disease (CAD) mortality were performed according to three therapeutic strategies (exclusive medical therapy, PCI or CABG). Cox regression models were used to estimate the hazard ratio (HR) with respective 95% confidence interval (95%CI) from 180 days to four years of follow-up after ACS. Models are presented as crude, age-sex adjusted and further adjusted for previous CAD, ACS subtype, smoking, hypertension, dyslipidemia, left ventricular ejection fraction and according to the number of obstructed (≥ 50%) major coronary arteries.
Results
Among 800 participants, the lowest crude survival rates were detected among individuals who underwent CABG (all-cause and CVD). CABG was correlated to CAD (HR: 2.19 [95% CI: 1.05-4.55]). However, this risk lost significance in the full model. PCI was associated to lower probability of fatal events during four-year follow-up: all-cause [multivariate HR: 0.42 (95% CI: 0.26-0.70)], CVD [HR: 0.39 (95% CI: 0.20-0.73)] and CAD [multivariate HR: 0.24 (95% CI: 0.09-0.63)] compared to those submitted to exclusive medical therapy.
Conclusion
In the ERICO study, PCI after ACS was associated to better prognosis, particularly CAD survival.
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