Prognostic Value Of 2020 ESC Criteria For High Risk Of Thrombosis In Patients With Acute Coronary Syndromes

Background:The 2020 European College of Cardiology(ESC)guidelines for non-ST-segment elevation acute coronary syndrome(NSTE-ACS)proposed new criteria for thrombotic risk,and adding a second antithrombotic agent to aspirin for extended long-term secondary prevention should be considered in patients with a high risk of ischemic events.The value of ESC criteria and DAPT score in the stratification of ischemic risk were assessed in this study.Methods:489 patients with acute coronary syndrome who received dual antiplatelet therapy(DAPT)at discharge from June 2020 to August 2020 were enrolled.The primary endpoint was the occurrence of major adverse cardiovascular events(MACE),which included recurrent ACS or unplanned revascularization,all-cause death or ischemic stroke during 27-months follow-up period.Results:Patients with ESC-defined high-risk showed significantly higher risk of MACE(HR 2.75,95%CI 1.78-4.25),all-cause death(HR 2.49,95%CI 1.14-5.43),and recurrent ACS or unplanned revascularization(HR 2.80,95%CI 1.57-4.99)than those with ESC-defined low/medium-risk during follow-up.The results of landmark analysis showed that patients in high-risk group had a significantly higher risk of MACE(HR 2.80,95 CI% 1.57-4.97),recurrent ACS or unplanned revascularization(HR 3.19,95 CI% 1.47-6.93)within one year and a higher risk of MACE(HR 2.69,95CI% 1.38-5.23)after one year.There was no significant difference in the incidence of MACE between patients with DAPT score ≥ 2 and DAPT score < 2.The C-indices of ESC criteria and DAPT score for prediction of MACE were 0.63(95%CI 0.57-0.70)and 0.54(95%CI 0.48-0.61),respectively.the predictive value of ESC criteria for MACE was better than the DAPT score according to the De Long test(z-statistic=2.30,P=0.020).Conclusion:Patients with ESC-defined high-risk had a higher risk of MACE than those with ESC-defined low/medium-risk.The discriminant ability of the ESC criteria was better than DAPT score for MACE.The ESC criteria demonstrated moderate discriminatory capacity with respect to 27 months of MACE in ACS patients treated with DAPT.