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Risk for Recurrent Cardiovascular Events and Expected Risk Reduction With Optimal Treatment 1 Year After an Acute Coronary Syndrome.

TitleRisk for Recurrent Cardiovascular Events and Expected Risk Reduction With Optimal Treatment 1 Year After an Acute Coronary Syndrome.
Publication TypeJournal Article
Year of Publication2020
AuthorsZafeiropoulos, S., Farmakis I., Kartas A., Arvanitaki A., Pagiantza A., Boulmpou A., Tampaki A., Kosmidis D., Nevras V., Markidis E., Papadimitriou I., Arvanitakis K., Sianos G., Makedou K., Ziakas A., Tzikas A., Karvounis H., & Giannakoulas G.
JournalAm J Cardiol
Volume133
Pagination7-14
Date Published2020 10 15
ISSN1879-1913
KeywordsAcute Coronary Syndrome, Aged, Aged, 80 and over, Cohort Studies, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Recurrence, Risk Assessment, Risk Factors, Risk Reduction Behavior, Time Factors
Abstract

According to the latest European Society of Cardiology Guidelines for the diagnosis and management of chronic coronary syndromes, patients who suffered an acute coronary syndrome fall into a chronic stable phase after 1 year. In these patients, the estimated 10-year risk for recurrent cardiovascular events varies considerably. We applied the SMART (Second Manifestations of Arterial Disease) risk score in 281 patients 1 year after an acute coronary syndrome to estimate the 10-year risk for recurrent cardiovascular events (subsequent nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death). We assessed the distribution of the estimated risk and the potential risk reduction that might be achieved with optimal guideline-directed management of modifiable risk factors (systolic blood pressure, low-density lipoprotein cholesterol, smoking, and body mass index). In our cohort, the median SMART score was 16.1% (interquartile range [IQR] 9.7 to 27.3), particularly increased in patients with older age, diabetes, polyvascular disease or chronic kidney disease (median 28.6%, IQR 20.8 to 52.9; 23.8%, 4.8 to 41.6; 29.4%, 18.8 to 49.7; 53.8%, 26.5 to 71.6, respectively). If all modifiable risk factors met guideline-recommended targets, the median SMART risk score would be 9.6% (IQR 6.3 to 20.9), with 51% of the patients at a 10-year risk <10%, while 11% and 15% at 20% to 30% and >30% risk, respectively. In conclusion, the SMART score had a wide distribution in patients with chronic coronary syndromes. A quarter of patients remained at a >20% 10-year risk, even with optimal risk factor management, clearly underlining that residual risk is an unmet clinical challenge.

DOI10.1016/j.amjcard.2020.07.046
Alternate JournalAm J Cardiol
PubMed ID32828524

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