Residual risk after acute coronary syndrome: the PRATO-ACS Registry

Abstract Background Despite administration of current evidence-based therapies, substantial residual risk for cardiovascular events persists, particularly after acute coronary syndrome (ACS). It is well known that different inflammatory, metabolic, renal factors concur in defining the residual risk, beyond lipids, platelets and coagulation. Purpose The purpose of this study is to analyze the prevalence of various residual risk factors in patients at 1 month after ACS and their association with all-cause death within 3 years. Methods Of the 1585 patients admitted to our center for ACS and included in the PRATO-ACS Registry we selected the 1099 patients (69±12 yrs; 30% female; 26.7% with diabetes; 73% NSTE-ACS and 27% STEMI) who underwent laboratory analyses 1 month after the index event. All patients had undergone early invasive strategy and received high intensity statins during hospitalization and at discharge. The frequency of 5 specific risk factors was evaluated: LDL cholesterol ≥70 mg/dl; high sensitivity C reactive protein (hs-CRP) ≥2 mg/l; triglycerides ≥135 mg/dl; high glycosylated hemoglobin (HbA1c) ≥6.5% in diabetic and ≥5.7% in non-diabetic patients; decrease in estimated glomerular filtration rate (eGFR) ≥25% compared to baseline. Patients were followed up for three years. The association between the individual risk factors and all-cause death within 3 years was evaluated with Cox proportional analysis expressed by hazard ratio (HR) and 95% confidence intervals (CI). Results The Table lists the prevalence of the five residual risk factors at 1 month and the mortality HR (95% CI) within 3 years for each risk factor. Conclusions After ACS, despite the secondary prevention therapy (high intensity statins), residual risk factors, all measured at 1 month, are persistently elevated in the majority of patients. Their association with all-cause death at 3 years is significantly high for inflammatory and metabolic parameters as well as renal function deterioration. These findings should prod us to develop new strategies that target all residual risk factors, not only lipid profile. Funding Acknowledgement Type of funding sources: None.