Meta-Analysis Highlights Acute Coronary Syndrome Risk Window

Kevin Kunzmann

New data suggest 90 days following an initial ACS event is the greatest time of likelihood for another high-risk event. How can this inform cardiovascular research?

New meta-analysis of 82,000-plus high-risk patients with acute coronary syndrome (ACS) show approximately half of all their reported major adverse cardiovascular events (MACE) occurred in the first 90 days following an initial ACS event.

The findings, presented at the American College of Cardiology (ACC) 2021 Scientific Sessions this weekend, provide a very distinct window of ACS patient vulnerability—and opportunity for caregiver preparedness and clinical assessment.

The investigators conducted the meta-analysis using 7 specified phase 3 interventional trials observing populations of high-risk patients with ACS. Their total search included 82,727 trial participants. Their analyzed trials included: TRITON-TIMI 38; PLATO; ATLAS ACS 2-TIMI 51; TRILOGY ACS; EXAMINE; AleCardio; and SOLID-TIMI 52.

The team observed pooled rates of recurrent MACE at 90 days (4.1%; 95% CI, 3.0 – 5.7) and 360 days (8.3%; 95% CI, 7.1 – 9.8), which were estimated from a random-effects model using the DerSimonian-Laird method.

Approximately 49% of the observed events occurred within the first 90 days of an ACS event.

In an interview with HCPLive during ACC 2021, study author C. Michael Gibson, MD, of the Baim Institute for Clinical Research, discussed the impact of the analyses’ findings, which also found that 60% of all events to occur in the first year of high-risk patients indeed fall in that 90-day window.

“In the past, we’ve gone out to 1 year on some studies, but now our thinking…is that most of that modifiable risk in the first 90 days,” Gibson said. "So going forward, we’re starting to move trials to a 30-90 day endpoint, where we have a lot of events we can find, and where the statistical power is greatest because we have higher event rates and we have therapies that can hopefully reduce them.”

The study, “Early and Late Recurrent Cardiovascular Risk in Patients with Recent Acute Coronary Syndrome – Meta-Analysis and Implications in Trial Design,” was presented at ACC 2021.