Risk Differences in Secondary Prevention Patients Who Present With Acute Coronary Syndrome and Implications of Guideline-Directed Cholesterol Management
Section snippets
Methods
The Northwestern Medicine Enterprise Data Warehouse (NMEDW) was queried to identify adult patients (age ≥18) who had an ACS event at Northwestern Memorial Hospital between January 1, 2014 and December 31, 2016. In the present study, ACS was defined as a left heart catheterization (LHC) with an associated International Classification of Disease versions 9 and 10 (ICD9/10) diagnosis of unstable angina pectoris, non-ST elevation myocardial infarction, or ST-elevation myocardial infarction. The
Results
Total 1,483 patients with 4,191 PY of follow-up were included (Figure 2). Median follow-up time was 3.3 years. Thirty-five percent of patients were female, 19% were African American, and the average age was 64 ± 13 years. About 1,027 (69%) were VHR and 456 (31%) were HR patients. There were 256 (25%) VHR patients who experienced the composite outcome compared with 41 (9%) of HR patients (p <0.001, Table 1).
The overall composite event incidence rate for our cohort was 61 ± 4.1 per 1,000 PY. In
Discussion
Our data from a large urban academic medical center showed that more than two-thirds (69%) of patients with an ACS event are considered VHR according the new 2018 ACC/AHA Cholesterol Guidelines. Our study is one of the first “real-world” estimates of this number in a US cohort. Although results may vary in different settings, we confirm that VHR patients are at significantly increased risk of developing cardiovascular morbidity and mortality following an ACS event. There were significantly
Author Contribution
Nathan W. Kong: Conceptualization, Methodology, Formal analysis, Data Curation, Writing - Original Draft, Writing - Review & Editing, Visualization Aakash Bavishi: Conceptualization, Methodology, Writing - Review & Editing Ansel Philip Amaral: Conceptualization, Methodology, Writing - Review & Editing Anjan Tibrewala: Conceptualization, Methodology, Writing - Review & Editing Arif Jivan: Conceptualization, Methodology, Writing - Review & Editing Philip Silberman: Software, Investigation, Data
Disclosures
The authors have nothing to disclose.
Acknowledgments
We would like to thank Dr. Scott Grundy, MD, PhD at the University of Texas Southwestern Medical Center for providing feedback on our study. We would also like to recognize Liqi Chen of the Biostatistics Collaboration Center at Northwestern University for her insight and expertise into the statistical analysis of our data.
Data Availability
The datasets generated and used during the current study are available from the corresponding author on reasonable request.
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Cited by (0)
Funding: None.