PURPOSE: The extent of coronary disease is a recognised predictor of mortality in survivors of acute coronary syndromes (ACS). The aim of this study was to assess predictors of multivessel disease at admission for ACS.
METHODS: A prospective observational study of 786 consecutive patients presented to a single coronary care unit, between May 2004 and July 2006, with ACS that underwent coronarioangiography during hospitalization. If the coronarioangiography showed significant stenosis in two or three-vessel patients were classified as having multi-vessel disease. Patients were followed-up for 12 months after ACS. Multivariate regression analysis was used to assess independent predictors of multivessel disease.
RESULTS: Multivessel disease was present in 340 patients (43%): 179 patients (23%) showed 2-vessel disease and 161 patients (20%) had 3-vessel disease. Patients with multivessel disease were significantly older, with more hypertension, previous myocardial infaction, diabetes, renal dysfunction and left bundle branch block, than those with one-vessel disease or no significant coronary disease. There were no significant differences regarding the type of ACS. In-hospital mortality was significantly higher in multi-vessel disease group (5.9% vs 2.7%, p<0.05). Regarding long-term outcomes, patients with multivessel-disease showed a higher proportion of MACE (30.9 vs 13.8%, p<0.001) and underwent more frequently PCI during follow-up (13.7 vs 5.4%, p<0.001). On multivariate analysis, glycaemia on admission > 125 mg/dl (OR 1.1–2.4, p<0.01), previous myocardial infarction (OR 1.0–1.9, p<0.05) and age > 65 (OR 1.0–2.1, p<0.05) were the only independent predictors of multi-vessel disease.
CONCLUSION: Older age and previous myocardial infarction were independent predictors of multi-vessel disease suggesting that the extent of coronary disease is proportional of the time of coronary disease evolution. However, the strongest predictor of multi-vessel disease was abnormal glucidic metabolism.
CLINICAL IMPLICATIONS: These results reinforced the importance of glucometabolic control in prevention of coronary disease.
DISCLOSURE: Natalia Antonio, None.