-Original-

Clinical Characteristics, Achievement of Secondary Prevention Goals, and Outcomes of Patients with Recurrent Acute Coronary Syndrome

Shuhei Tara¹, Takeshi Yamamoto¹, Shin Sakai¹, Tokuhiro Kimura¹, Kazuhiro Asano¹, Yuhi Fujimoto¹, Reiko Shiomura¹, Junya Matsuda¹, Kosuke Kadooka¹, Kenta Takahashi¹, Toshinori Ko¹, Hideto Sangen¹, Yoshiyuki Saiki¹, Jun Nakata¹, Yusuke Hosokawa¹, Hitoshi Takano² and Wataru Shimizu^1,2

¹Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Tokyo, Japan
²Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan

Background: Because development of acute coronary syndrome (ACS) worsens the prognosis of patients with coronary artery disease, preventing recurrent ACS is crucial. However, the degree to which secondary prevention treatment goals are achieved in patients with recurrent ACS is unknown.
Methods: 214 consecutive ACS patients were classified as having First ACS (n=182) or Recurrent ACS (n=32), and the clinical characteristics of these groups were compared. Fifteen patients died or developed cardiovascular (CV) events during hospitalization, and the remaining 199 patients were followed from the date of hospital discharge to evaluate subsequent CV events.
Results: Patients in the Recurrent ACS group were older than those in the First ACS group (76.8±10.8 years vs 68.8±13.4 years, p=0.002) and had a higher rate of diabetes mellitus (DM) (65.6% vs 36.8%, p=0.003). The rate of achieving a low-density lipoprotein cholesterol (LDL-C) level of <70 mg/dL in the Recurrent ACS group was only 28.1%, even though 68.8% of these patients were taking statins. An HbA1c level of <7.0% was achieved in 66.7% of patients with recurrent ACS who had been diagnosed with DM. Overall, 12.5% of patients with recurrent ACS had received optimal treatment for secondary prevention. CV events after hospital discharge were noted in 37.9% of the Recurrent ACS group and 21.2% of the First ACS group (log-rank test: p=0.004). However, recurrent ACS was not an independent risk factor for CV events (adjusted hazard ratio: 2.09, 95% confidence interval: 0.95 to 4.63, p=0.068).
Conclusion: Optimal treatment for secondary prevention was not achieved in some patients with recurrent ACS, and achievement of the guideline-recommended LDL-C goal for secondary prevention was especially low in this population.

J Nippon Med Sch 2021; 88: 432-440

Keywords
cardiovascular events, low-density lipoprotein cholesterol, optimal medical therapy, comprehensive risk factor control

Correspondence to
Shuhei Tara, MD, PhD, Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
s5062@nms.ac.jp

Received, September 13, 2020
Accepted, December 11, 2020