Effect of comorbidities on the prognosis of patients with acute coronary syndromes

Background: To evaluate the impact of cardiovascular (CV) and non-cardiovascular (non-CV) comorbidity in real life pts with ACS. Methods: From 1997 to 2007 all consecutive pts admitted in 24h of ACS, were studied. CV and non-CV comorbidity data were collected. Non-CV comorbidity included renal insufficiency, COPD, malignancy, endocrine gland dysfunction, anaemia, gastrointestinal disease, rheumatic and chronic inflammatory diseases, neurological/mental/psychiatric status, infections, dental hygiene and alcohol use. Pts socioeconomic status was collected. In-hospital mortality and 1-year composite of death and re-hospitalisation due to MI or heart failure were studied. Results: A total of 8,455 pts were studied, including 3,585 STEMI (or new LBBB) and 4,870 NSTE-ACS pts. By multivariate Cox regression analysis signs of heart failure (HR=4.89; p 5mg/L (HR=1.21; p=0.034) were the independent non-CV factors of in-hospital mortality. By 1-year, after discharge, 24.8% pts died due to CV reasons or re-hospitalised due to MI or heart failure. By multivariate Cox regression analysis, no reperfusion or revascularization (HR= 3.51; p 5mg/L (HR=1.52; p<0.001) and moderate alcohol use (HR=0.78; p<0.001) were the independent non-CV predictors. Conclusions: Several CV and non-CV conditions seem to contribute to the final short- and long-term outcome of real life ACS patients. More comprehensive risk scores based on such data sets would be useful for more accurate risk stratification in this setting.