Huo Yong, Lee Stephen W-L, Sawhney Jitendra P S, Kim Hyo-Soo, Krittayaphong Rungroj, Pocock Stuart J, Nhan Vo T, Alonso-Garcia Ángeles, Chin Chee Tang, Jiang Jie, Jan Stephen, Vega Ana M, Hayashi Nobuya, Ong Tiong Kiam
Peking University First Hospital, Beijing, China.
Queen Mary Hospital, Hong Kong, China.
Int J Cardiol. 2020 Sep 15;315:1-8. doi: 10.1016/j.ijcard.2020.05.022. Epub 2020 May 7.
Approximately half of cases of cardiovascular disease (CVD) worldwide occur in Asia, with acute coronary syndrome (ACS) a leading cause of mortality. Long-term ACS-related outcomes data in Asia are limited. This analysis examined 2-year ACS-related outcomes in patients enrolled in the EPICOR Asia study, and the association between patient characteristics and management on outcomes.
EPICOR Asia is a multinational, prospective, primary data collection study of real-world management of Asian patients with ACS. Overall, 12,922 eligible adults (hospitalized for ACS within 48 h of symptom onset and who survived to discharge) were enrolled from 219 centers in eight Asian countries. Patients were followed up post-discharge for 2 years and clinical outcomes recorded.
Patients were of mean age 60 years and 76% were male. Diagnoses were STEMI (51.2%), NSTEMI (19.9%), and UA (28.9%). During follow-up, 5.2% of patients died; NSTEMI patients had the highest risk profile. Mortality rate (adjusted HR [95% CI]) was similar in NSTEMI (0.97 [0.81-1.17]) and lower in UA (0.52 [0.33-0.82]) vs STEMI. Similar trends (adjusted) were seen for the composite endpoint of death, myocardial infarction, or ischemic stroke, and bleeding rates did not differ significantly. For all three diagnoses, patients who were medically managed had a markedly elevated risk of both death and the composite endpoint.
During 2-year follow-up, adjusted risks of mortality, the composite endpoint, and bleeding rates were similar in NSTEMI and STEMI patients. Outcomes risk was better for invasive management. Long-term management strategies in Asia need to be optimized.
全球约一半的心血管疾病（CVD）病例发生在亚洲，急性冠状动脉综合征（ACS）是主要死因。亚洲地区与ACS相关的长期结局数据有限。本分析研究了参与EPICOR Asia研究的患者的2年ACS相关结局，以及患者特征与治疗对结局的影响。
EPICOR Asia是一项针对亚洲ACS患者实际治疗情况的多中心、前瞻性、原始数据收集研究。总共从8个亚洲国家的219个中心纳入了12922名符合条件的成年人（症状发作后48小时内因ACS住院且存活至出院）。患者出院后随访2年并记录临床结局。
患者平均年龄为60岁，76%为男性。诊断为ST段抬高型心肌梗死（STEMI，51.2%）、非ST段抬高型心肌梗死（NSTEMI，19.9%）和不稳定型心绞痛（UA，28.9%）。随访期间，5.2%的患者死亡；NSTEMI患者风险最高。NSTEMI患者的死亡率（校正后HR[95%CI]）与STEMI相似（0.97[0.81 - 1.17]），UA患者较低（0.52[0.33 - 0.82]）。死亡、心肌梗死或缺血性卒中的复合终点也有类似趋势（校正后），出血率无显著差异。对于所有三种诊断，接受药物治疗的患者死亡和复合终点风险均显著升高。
在2年随访期间，NSTEMI和STEMI患者校正后的死亡率、复合终点风险和出血率相似。侵入性治疗的结局风险更好。亚洲的长期治疗策略需要优化。
