Outcomes in Working Age First-Acute Coronary Syndrome Patients: The ANZACS-QI New Zealand National Cohort

Abstract

Background: Patients who experience acute coronary syndrome (ACS) at younger ages are at risk of many years of potential life lost and of poor health outcomes. We have recently shown that in New Zealand (NZ) a high proportion of patients admitted for first ACS are young and that these patients have a very high risk factor burden. The acute management at the time of presentation with ACS has improved but the subsequent health outcomes for these younger patients are currently uncertain. Purpose: To describe the clinical outcomes following admission for first-ACS for a contemporary NZ patient group, with a focus on working-age people and the subsequent burden of disease. Methods: The All New Zealand Acute Coronary Syndrome Quality Improvement programme (ANZACS-QI) is a web-based registry collecting comprehensive data for all patients admitted with ACS at all public hospitals in NZ. This analysis includes patients with confirmed first-time ACS and no history of atherosclerotic disease enrolled in the registry from 01/01/2012-31/12/2016. Outcomes were sourced from national datasets and include (a)all-cause mortality, (b)cardiovascular (CV) readmissions, and a combined endpoint (a)+(b), with a median follow-up time of 1.2 years (range 0-5 years). Results: 14222 patients had first-time ACS, 68% male, mean age 63 years. Compared to older patients, those of working age (aged <65 years, 54% of the cohort) had a higher burden of CV risk factors, including BMI ≥30 (43%vs29%), current smoking (35%vs10%) and total cholesterol:HDL ratios ≥4.0 (68%vs46%), all p<0.001. Overall, 25% of the patients had either died or had a CV readmission within 12 months, and the proportion increased with increasing age. In patients aged <65 years, 20% died or were readmitted for CV reasons within 12 months of their first-ACS. In these younger patients, those who experienced subsequent death or readmission had a higher overall risk factor burden, with 23% having ≥3 of current smoking, diabetes, BMI≥30, or total cholesterol:HDL ratios ≥4.0 compared with 18% of those without subsequent events (p=0.003). Conclusion: Overall, more than half of the patients presenting with first-time ACS were age <65yrs, and one in five of these patients died or were readmitted for CV reasons within 12 months. While at relatively lower risk than older patients, the high proportion of patients aged <65 years experiencing subsequent events after first ACS confers a heavy burden of disease during what are potentially productive working years. The higher risk factor burden and subsequent high rate of clinical events identifies the need for a longer-term focus on strategies to improve clinical outcomes following first-time ACS.