G. Berton, R. Cordiano, F. Cavuto, H. Mahmoud, H. Asklany, M. Pasquinucci, B. Segafedo
CONEGLIANO GENERAL HOSPITAL, CONEGLIANO; ADRIA GENERAL HOSPITAL, ADRIA; BASSANO DEL GRAPPA GENERAL HOSPITAL, BASSANO DEL GRAPPA; THE ABC HEART DISEASE FOUNDATION, CONEGLIANO; MINIA UNIVERSITY HOSPITAL, MINIA

Hypertension (HTN) and albuminuria are important predictors for all cause and cardiac mortality.
Purpose: To evaluate their association with sudden (SCD), non–sudden (non–SCD) and non cardiac death (non–CD) after acute coronary syndrome (ACS) during 20 years o ollow–up.

Methods: This study includes 589 patients with ACS enrolled in three centres and discharged alive. Baseline clinical and laboratory data were gathered within the first 7 days of hospitalization. Survival analysis using a competitive risk regression model was done to investigate the prognostic relationship of HTN and albuminuria with the 3 causes of death.

Results: During 20 years o ollow–up, 437 (74.1%) patients died; they were significantly dierent for many clinical features from living patients. Of them; 174(40%) suered non–SCD, 91(21%) SCD while 172(39%) had non–CD. Female gender, diabetes mellitus, HTN, albuminuria were more prevalent in patients with non–SCD, (p ¼0.02, p ¼0.001, p ¼0.003 and p ¼0.04 respectively), they also were older and had higher values 3rd day albumin creatinine ratio (p ¼0.01 for each); while patients with SCD had history o nfarction, heart failure (HF), Q wave myocardial infarction at presentation (Q–MI) more frequently (p ¼0.009, p¼0.001 and p ¼0.008) respectively. Only 3 patients did not complete the follow–up and their time was censored before 20 years. At univariate competing risk analysis; presence of both HTN and albuminuria was associated with non–SCD risk, hazard ratio (HR) ¼1.5(95%CI¼1.3–1.7) p < 0.000. Same results were obtained using a multivariable model (adjusted for age, gender, smoking, DM, serum cholesterol, HF and Q–MI) (HR) ¼1.3(95%CI¼1.1–1.5) p ¼0.001. No associations were found with SD or non–CD.

Conclusions: The Presence of hypertension and albuminuria during ACS is independently associated to non–SCD and not to SD. This observation emphasizes the diverse pathophysiology of sudden and non sudden cardiac death at least after ACS.

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