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Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea, Department of Rehabilitation Medicine1, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea, Department of Rehabilitation Medicine2 |
Objective: Coronary heart disease (CHD) remains the leading cause of mortality and morbidity throughout the world. Inadequate control of cardiovascular risk factors is involved in the progression of atherosclerotic diseases and re-hospitalizations for recurrent acute coronary syndrome (ACS) are not uncommon. In this study, we investigate the risk factors associated with recurrence of ACS after first attack.
Subjects & Methods: The subjects of this study were patients who were hospitalized from January 1st, 2009 to December 31st, 2019 at one university hospital due to ACS and received either percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG), at least once. Then, they were divided into “recurrent group” who were hospitalized more than once after first attack and “incident group” who received one intervention. The medical records of each group were reviewed for prevalence among comorbidities and individual characteristics. All possible subset regression analysis were applied. Then, multivariate logistic regression modeling was performed to estimate the predictors of recurrence.
Results: During the study period, a total of 2611 ACS patients were hospitalized for ACS. There were recurrences in 279 patients and 150 patients who were not lost in follow-up were selected. 150 out of 2332 patients without recur, were randomly selected to match the number. Logistic regression analysis showed that weight, smoking at initial diagnosis, numbers of diseased vessels and comorbidity of hypertension (HTN) and diabetes mellitus (DM) were significant independent risk factors for recurrence. Also, the numbers of risk factors among three categorical variables, which are HTN, DM and smoking, showed significant effect on odds of recurrence. Having one factor showed odds ratio (OR) of 1.83 (CI:1.08-3.09, P=0.023). For two and three risk factors, the OR were 6.26 (CI:2.85-13.73, P<0.001) and 13.02 (CI:1.54-110.07, P=0.018) each. Especially, patients with DM and smoking history showed OR of 12.00 (CI:3.43-41.9, P<0.001) which is as high as having all three risk factors.
Conclusion: There were prior studies which analyzed risk factors of ACS recurrence. DM and numbers of affected vessels are well known risk factors. Factors like age, female gender, ejection fraction and types of infarction which are reported to increase the risk, showed no significance in this study. Smoking at initial diagnosis, weight, comorbidity of HTN were significant factors for recurrence in our study, though they are less mentioned. In this study, we also evaluated the effect on odds of recurrence when patients had multiple risk factors. Since the presence of multi-risk factors significantly increases hazard of ACS recurrence, cardiac rehabilitation programs should require thorough risk factor management very strictly including medication adherence, patient education and life style modification as well as exercise therapy.
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