Temporal trends of patients with acute coronary syndrome and multi-vessel coronary artery disease - from the ACSIS registry

Introduction: Multi-vessel coronary artery disease (MV-CAD) is common among patients with acute coronary syndrome (ACS) and is associated with worse outcomes. Objectives: To examine temporal trends of patients presenting with ACS and MV-CAD. Methods: Time-dependent analysis of patients enrolled in the ACS Israeli Surveys (ACSIS) between 2004–2016 by 3 time periods: early (2004–2006; n = 2111), mid (2008–2010; n = 2049), and late (2013–2016; n = 2010). MV-CAD was defined as >50% stenosis in ≥2 separate coronary territories at the index coronary catheterization. Outcomes were 30-day MACE and 1-year all-cause mortality. Results: Overall 6170/9321 patients (66%) had MV-CAD (age 64.5 ± 12.1, males 80%). Patients from later periods were older with a higher prevalence of cardiovascular risk-factors and comorbidity. Among patients with MV-CAD, STEMI decreased significantly (early-46% vs. late-37%, p < 0.001). The rates of PCI were similar, however rates of MV-PCI have increased (early-16.8% vs. late −37.1%, p < 0.001) while the rates of CABG decreased over-time (early-12.7% vs. late −9.2%, p < 0.001). Thirty-day outcomes improved significantly; MACE (early-18.2%, mid-12.6%, late-11.2%, p < 0.001), mortality (early-4.7%, mid-4.2%, late-3.1%, p = 0.03) and re-infarction (early = 3.0%, mid = 2.4% and late 1.1%, p < 0.001). No significant change in 1-year mortality was observed (early = 9.3%, mid = 7.8%, late = 7.7%, p = 0.13). A multivariate adjusted analysis demonstrated that the mid and late periods (vs. the early period) were associated with significantly reduced risk for 30-day MACE (OR = 0.65 [0.54–0.77] and 0.54 [0.45–0.65], respectively). Conclusions: During the last decade, the burden of cardiovascular risk factors among ACS patients with MV- CAD has increased, more invasive treatment was provided and a significant improvement in 30-day outcomes was observed.