The Impact of Myocardial Revascularization After Acute Coronary Syndromes on One-Year Cardiovascular Mortality

Abstract

The aim of this observational study was to evaluate the impact of myocardial revascularization performed after acute coronary syndromes on one-year cardiovascular mortality. Material and Methods. The study population comprised 1226 consecutive patients who were admitted to the Clinic of Cardiology in 2005 because of acute coronary syndromes with significant (≥70%) coronary artery stenoses. The relationship between myocardial revascularization and oneyear cardiovascular mortality was evaluated by applying multivariable logistic regression. Cardiovascular mortality was evaluated using the Kaplan-Meier method. Results. Of all the patients included into the study, 540 had Q-wave myocardial infarction, 339 patients had non–Q-wave myocardial infarction, and 347 patients were treated for unstable angina pectoris. During hospitalization, 496 patients underwent percutaneous transluminal coronary angioplasty, 373 patients underwent coronary artery bypass grafting within 60 days following acute coronary syndromes, and 357 patients received pharmacological treatment alone. During one-year follow-up, 105 cases of cardiovascular death were registered. The one-year cardiovascular mortality was significantly lower in patients who underwent percutaneous transluminal coronary angioplasty or coronary artery bypass grafting comparing with those patients who received only pharmacotherapy (5.4% and 7.8% vs. 14.3%, P<0.05). Multivariate logistic regression analysis revealed that myocardial revascularization independently reduced one-year cardiovascular mortality (adjusted odds ratio for percutaneous transluminal coronary angioplasty, 0.304; 95% CI, 0.18 to 0.53; P<0.001, and coronary artery bypass grafting, 0.540; 95% CI, 0.32 to 0.90; P=0.018) in patients who were admitted because of acute coronary syndromes. Conclusions. Myocardial revascularization performed after acute coronary syndromes was significantly associated with the reduction of cardiovascular mortality within one-year period independently of clinical variables.