One-year Mortality after an Acute Coronary Event and its Clinical Predictors: The ERICO Study

Abstract

Background: Information about post-acute coronary syndrome (ACS) survival have been mostly short-term findings or based on specialized, cardiology referral centers. Objectives: To describe one-year case-fatality rates in the Strategy of Registry of Acute Coronary Syndrome (ERICO) cohort, and to study baseline characteristics as predictors. Methods: We analyzed data from 964 ERICO participants enrolled from February 2009 to December 2012. We assessed vital status by telephone contact and official death certificate searches. The cause of death was determined according to the official death certificates. We used log-rank tests to compare the probabilities of survival across subgroups. We built crude and adjusted (for age, sex and ACS subtype) Cox regression models to study if the ACS subtype or baseline characteristics were independent predictors of all-cause or cardiovascular mortality. Results: We identified 110 deaths in the cohort (case-fatality rate, 12.0%). Age [Hazard ratio (HR) = 2.04 per 10 year increase; 95% confidence interval (95% CI) = 1.75-2.38], non-ST elevation myocardial infarction (HR = 3.82; 95% CI = 2.21-6.60) or ST elevation myocardial infarction (HR = 2.59; 95% CI = 1.38-4.89) diagnoses, and diabetes (HR = 1.78; 95% CI = 1.20-2.63) were significant risk factors for all-cause mortality in the adjusted models. We found similar results for cardiovascular mortality. A previous coronary artery disease diagnosis was also an independent predictor of all-cause mortality (HR = 1.61; 95% CI = 1.04-2.50), but not for cardiovascular mortality. Conclusions: We found an overall one-year mortality rate of 12.0% in a sample of post-ACS patients in a community, non-specialized hospital in Sao Paulo, Brazil. Age, ACS subtype, and diabetes were independent predictors of poor one-year survival for overall and cardiovascular-related causes.