Long-term consequences and secondary prevention in patients who suffered acute coronary syndrome in real clinical practice based on the results of a 12-year follow-up

Abstract

BACKGROUND: The analysis of the long-term consequences of acute coronary syndrome (ACS) revealed a high incidence of complications and their probable relationship with defects in secondary prevention, which allows us to determine the direction of elimination of such defects. AIM: To assess the long-term consequences of ACS and the effectiveness of secondary prevention. MATERIALS AND METHODS: The study included 255 patients who were sequentially hospitalized in the Regional Vascular Center of Petrozavodsk for ACS in 2009–2010. In the period from October 2021 to February 2022, electronic medical record data were retrospectively analyzed to assess the effects of ACS and the effectiveness of secondary prevention. RESULTS: Data from 155 patients were analyzed, among whom men predominated (n=113, 72.9%). The mortality rate was high, with a significant prevalence of adverse effects of ACS. The 12-year mortality was 42.6% (66 people), and the average age of the deceased was 62.1±6.8 years. Chronic heart failure was diagnosed in 50 (32.3%) patients. Thirty-five of them had stage IIa (72.9% among 48 patients with a known stage), and 26 had functional class II (FC; 68.4% among 38 patients with a known FC). Stable angina pectoris was diagnosed in 41 patients (26.5%), 26 (66.7% among 39 patients with known FC) had symptoms of FC II, and 31 (20%) had recurrent ACS. Percutaneous intervention was performed in 65% of cases (n=20). Cardiac arrhythmias and conduction disorders were recorded in 41 (26.5%) patients: 15 of them (36.6%) were diagnosed with ventricular extrasystole of high grade (grade IV according to Ryan), and atrial fibrillation/flutter developed in 22 (14.2% of all observed) patients. Data indicate a lack of commitment to the principles of secondary prevention for both patients and doctors, except for quitting smoking. Six patients (3.9%) continued to smoke. Moreover, increased body weight persisted in 33 patients (21.3%). The prescription rate for necessary medications was low; acetylsalicylic acid was prescribed to 61 (39.4%) patients, blockers of the renin–angiotensin–aldosterone system to 74 (47.7%), beta-blockers to 74 (47.7%), and statins to 69 (44.5%), which does not allow achieving the target levels of therapy. The target blood pressure was achieved only in 68 patients (43.9%), heart rate in 23 (14.8%), and lipid spectrum in 2 (1.3%). CONCLUSION: This study revealed the high incidence of adverse effects of ACS in the long-term period, which, apparently, is a consequence of low adherence to lifestyle modifications and drug correction of risk factors.