Clinical characteristics, secondary prevention goal attainment, and outcomes of patients with recurrent acute coronary syndrome.

BACKGROUND Because acute coronary syndrome (ACS) development worsens the prognosis of patients with coronary artery disease, preventing recurrent ACS is crucial. However, the degree to which secondary prevention treatment goals in recurrent ACS patients are achieved is unknown. METHODS Consecutive 214 ACS patients were divided into two groups; First ACS (n=182) and Recurrent ACS (n=32), and compared clinical characteristics between the groups. Fifteen patients developed death or cardiovascular (CV) events during hospitalization, and remained 199 patients were followed from the date of hospital discharge to evaluate subsequent CV events. RESULTS Patients in the Recurrent ACS group were older (76.8±10.8 years vs 68.8±13.4 years, p=0.002) and had a higher rate of diabetes mellitus (DM) (65.6% vs 36.8%, p=0.003) than those in the First ACS group. The attainment rate of low-density lipoprotein cholesterol (LDL-C) < 70mg/dl in the Recurrent ACS group was only 28.1%, despite 68.8% of these patients receiving statin. HbA1c < 7.0% was achieved in 66.7% of recurrent ACS patients who had been diagnosed with DM. Overall, 12.5% of recurrent ACS patients had received optimal treatment for secondary prevention. CV events after hospital discharge were identified in 37.9% of the Recurrent ACS group and 21.2% of the First ACS group (log-rank: p=0.004). However, recurrent ACS was not an independent risk factor for CV events (adjusted hazard ratio: 2.09, 95% confidence interval: 0.95 to 4.63, p=0.068). CONCLUSION Optimal treatment for secondary prevention in recurrent ACS patients was insufficient. Attainment of the guideline-recommended LDL-C goal for secondary prevention was especially low in recurrent ACS patients.