Correlation Study On Prognostic Factors Of Acute Coronary Syndrome In The Elderly

Background and ObjectiveLipoprotein(a)[Lp(a)]has been suggested as an independent risk factor for cardiovascular events in patients with coronary artery disease.Acute coronary syndrome(ACS)is a serious type of coronary heart disease(CHD),which is common and has a poor prognosis in elderly patients.Patients of very advanced age(?80 years)with ACS are often underrepresented in large-scale clinical studies.The clinical evidence on the association between Lp(a)and prognosis of very advanced-age patients with ACS is inadequate.The present study aimed to investigate the association of Lp(a)with long-term poor prognosis following acute coronary syndromes(ACS)in the advanced-age patients.MethodsWe enrolled 536 patients aged?80 years hospitalized for ACS and plasma Lp(a)concentrations were measured at admission.The primary outcomes were hard CHD events(a composite of myocardial infarction and CHD death).The secondary outcomes included major adverse cardiovascular events(MACEs),all-cause death and cardiac death.MACEs were defined as all-cause death,non-fatal myocardial infarction,unplanned target vessel revascularization,readmission for heart failure and non-fatal stroke or transient ischemic attack.ResultsDuring a median 66-month follow-up,89 hard CHD events occurred.234 MACEs,143 all-cause death events and 64 cardiac death events were recorded during follow-up.The optimal cutoff points of Lp(a)levels were obtained from receiver operating characteristic curve analyses.Kaplan-Meier curves showed significantly higher cumulative incidences of hard CHD events,MACEs,all-cause death and cardiac death in high Lp(a)group than that in low Lp(a)group(Log-rank,P<0.05).Multivariate Cox proportional hazards analyses revealed that elevated Lp(a)levels were independently associated with increased risks of hard CHD events[hazard ratio(HR):1.714,95%confidence interval(95%CI):1.114-2.638],MACEs(HR 1.354,95%CI:1.024-1.790),all-cause death(HR 1.804,95%CI:1.286-2.532)and cardiac death(HR 1.891,95%CI:1.112-3.217).Furthermore,adding Lp(a)to the prognostic model for hard CHD events improved the C-statistic value(P<0.05).ConclusionElevated Lp(a)levels were independently associated with the increased risks of hard CHD events,MACEs,all-cause death and cardiac death in the advanced-age patients with ACS,which indicated that routine screening for Lp(a)might aid prognosis and risk assessment.Background and ObjectiveAcute coronary syndrome(ACS)is a serious type of coronary heart disease,which is common and has a poor prognosis in elderly patients.The clinical evidence on the prognostic factors of very advanced-age patients with ACS is inadequate.N-terminal pro-brain natriuretic peptide(NT-proBNP)has been proved to be associated with the prognosis of patients with coronary heart disease.This study aimed to explore the correlation between NT-proBNP level and the severity of the disease in the elderly patients with ACS,and the impact of NT-proBNP on the prognosis at 1 year after discharge and long-term prognosis following ACS in the very advanced-age patients.MethodsWe included 338 patients aged?80 years hospitalized for ACS.Plasma NT-proBNP concentrations and GRACE scores were assessed at admission.Major adverse cardiovascular events(MACE)at 1 year after discharge and during long-term follow-up were recorded.MACEs were defined as all-cause death,non-fatal myocardial infarction,unplanned target vessel revascularization,readmission for heart failure and non-fatal stroke or transient ischemic attack.ResultsPatients were divided into two groups:high NT-proBNP group and low NT-proBNP group,according to the upper quartile of NT-proBNP(1228.7pg/mL).Compared with the patients with low NT-proBNP levels,those with high NT-proBNP levels manifested a higher level of GRACE scores and a higher proportion of high-risk patients(GRACE>140)(P<0.05).Spearman correlation analysis showed that NT-proBNP levels were significantly positively correlated with GRACE scores(P<0.001).Receiver operating characteristic curves showed that NT-proBNP could predict the risks of MACEs at 1 year after discharge and during long-term follow-up in elderly patients with ACS(P<0.05).Overall,24 developed MACEs at 1 year after discharge.During a median 63-month follow-up,152 MACEs occurred.Kaplan-Meier curves showed significantly higher cumulative incidences of MACEs at 1 year after discharge and during long-term follow-up in the high NT-proBNP group than that in the low NT-proBNP group(P<0.05).Multivariate Cox proportional hazards analysis demonstrated that high levels of NT-proBNP were significantly associated with the increased risks of MACEs at 1 year after discharge and during long-term follow-up(P<0.05).ConclusionNT-proBNP levels were significantly positively correlated with GRACE scores.Elevated NT-proBNP was an independent risk factor of MACEs at 1 year after discharge and during long-term follow-up in the elderly patients with ACS.