ESC Criteria & acute coronary syndrome | IJGM

Introduction

The 2020 European Society of Cardiology (ESC) guidelines on non-ST segment elevation acute coronary syndrome (NSTE-ACS) recommend 12-month dual antiplatelet therapy (DAPT) for patients with NSTE-ACS. However, the risk of residual ischemia in ACS patients remains high under the standard antiplatelet strategy. Some large randomized trials have shown that adding a second antithrombotic agent to aspirin after 12 months of DAPT can further reduce the incidence of adverse events. Therefore, an intensified strategy for prolonging DAPT duration should be considered for high-risk patients.

Methods

Study Population

A total of 489 patients admitted to the Second Affiliated Hospital of Nanchang University for ACS who received DAPT at discharge were recruited between June and August 2020. The inclusion criteria were diagnosed with ACS, age ≥ 18 years old, and received one or more coronary angiography (CAG) during hospitalization. The exclusion criteria were complicated with a life-threatening malignant tumor, died during hospitalization or within 10 days after discharge, refused CAG and further drug treatment during hospitalization, diagnosed with stable angina pectoris or myocardial bridge, and did not use DAPT at discharge.

Risk Stratification

The high ischemic risk was defined as complex coronary artery disease and at least 1 criterion, which included eight risk enhancers and five technical aspects. The moderate ischemic risk was defined as non-complex coronary artery disease and at least 1 criterion. The DAPT score consisted of 9 variables. Patients with a score ≥2 had a higher risk of ischemic events than those with a score <2.

Endpoint Definition and Follow-Up

The primary endpoint was defined as a major adverse cardiovascular event (MACE), which included all-cause death, recurrent ACS or unplanned revascularization (UR), and ischemic stroke. Follow-up data were obtained through phone contact or medical records. All patients were followed up for at least 24 months.

Results

Patients in the high-risk group had a significantly higher risk of MACE, all-cause death, recurrent ACS or UR compared to the low/moderate-risk group. There was no significant difference in the risk of MACE, all-cause death, recurrent ACS or UR, and ischemic stroke between patients with DAPT score ≥2 and those with DAPT score <2. The C-statistic of the ESC criteria for prediction of MACE was higher than that of the DAPT score.

Discussion

The ESC criteria showed moderate discriminative ability for predicting MACE in Asian patients with ACS. The DAPT score could not fully identify the risk of MACE in these patients. Accurate identification of patients with a high risk of ischemic events is crucial in treatment allocation.

Conclusion

The ESC criteria can determine the ischemic risk in patients with ACS and have certain prospects in clinical practice. However, further validation is needed.

SDGs, Targets, and Indicators

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-Being
• SDG 10: Reduced Inequalities

The article discusses the management of acute coronary syndrome (ACS) and the need for personalized treatment strategies based on individual patient characteristics. This aligns with SDG 3, which aims to ensure healthy lives and promote well-being for all at all ages. The article also mentions the differences in treatment outcomes and risk factors between different populations, highlighting the importance of reducing inequalities in healthcare (SDG 10).

2. What specific targets under those SDGs can be identified based on the article’s content?

• SDG 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
• SDG 10.2: By 2030, empower and promote the social, economic, and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.

The article emphasizes the need for personalized treatment strategies to reduce the risk of adverse events in patients with ACS. This aligns with SDG 3.4, which aims to reduce premature mortality from non-communicable diseases through prevention and treatment. Additionally, the article discusses the differences in treatment outcomes between different populations, highlighting the importance of promoting social and economic inclusion for all individuals, regardless of their characteristics or status (SDG 10.2).

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, the article mentions several indicators that can be used to measure progress towards the identified targets:

• Incidence of major adverse cardiovascular events (MACE)
• All-cause death rate
• Recurrence of ACS or unplanned revascularization (UR)
• Ischemic stroke rate

These indicators can be used to assess the effectiveness of personalized treatment strategies in reducing premature mortality and improving patient outcomes. They can also help evaluate the impact of interventions aimed at reducing inequalities in healthcare and promoting social inclusion.

Table: SDGs, Targets, and Indicators

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Source: dovepress.com

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