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After an acute coronary syndrome (ACS), optimal medical therapy (OMT) has been shown to be effective in reducing subsequent cardiovascular (CV) events. However, even in populations that reach recommended secondary prevention goals, there is a subset of patients that experience subsequent CV events.To identify biological or clinical predictors of residual risk of CV events in post-ACS patients receiving OMT.A total of 990 post-ACS patients benefited from OMT (optimized treatment during the acute and chronic post-ACS phase, along with a therapeutic and dietary education programme). Traditional CV risk factors and atheroma disease markers (intima-media thickness measurement, carotid atheroma, peripheral arterial disease (PAD) measured by ankle brachial index, and the number of coronary arteries with a50% stenosis) were evaluated at 3 months post ACS. Cardiovascular events were recorded at follow up.At 20-month follow up,80% of the patients reached the recommended secondary prevention goals. In this population, diabetes was the only CV risk factor significantly associated with CV events in multivariate analysis including traditional risk factors (HR 1.61, p = 0.017). In multivariate analyses including CV risk factors and atheroma disease markers, only PAD remained significantly associated with CV events (HR 1.83, p = 0.04). The number of vascular beds involved was associated with poorer prognosis (HR for disease in 3-vascular-beds 3.85, p = 0.001, using disease in 1-vascular-bed as a reference group).In post-ACS patients with OMT, atheroma burden is a powerful prognostic marker of recurrent CV events, while diabetes remains the only independent marker of CV events among traditional CV risk factors.

Background After an acute coronary syndrome (ACS), pharmacologic therapy and lifestyle intervention (optimal medical therapy, OMT) are efficient in reducing cardiovascular (CV) events. However, even if recommended secondary prevention goals are reached, a subset of patients still present CV events. Aim To identify biological or cardiovascular markers predicting the residual risk of CV events in post-ACS patients receiving OMT. Patients and methods 990 patients benefited from an evaluation of risk factors and atherosclerosis lesions, and optimization of long-term treatment and education. Traditional CV risk factors and atheroma disease markers (intima-media thickness (IMT), carotid atheroma, Ankle Brachial Index (ABI) and number of coronary arteries with >50% stenosis) were evaluated 3 months after ACS. CV events were recorded at follow-up (CV death, ACS, stroke, heart failure, revascularization). Results At a median follow-up of 20 months, more than 80% of the patients reached recommended prevention goals. 116 total CV events were recorded. Diabetes was the only CV risk factor significantly associated with CV events in multivariate analysis (including age, sex, hypertension, LDL cholesterol, smoking, diabetes and hsCRP); HR 1,61 (1,09–2,39), p = 0,017. In multivariate analysis including CV risk factors and atheroma disease markers (peripheral vascular disease (PVD) defined as ABI 50%, IMT >0,7 mm, 3-vessel and/or left main coronary disease), only PVD remained significantly associated with CV events; HR 1,83 (1,02–3,31), p = 0,04. The number of vascular beds involved was associated with poorer prognosis: HR for 3 vascular-beds disease 3,85 (1,72–8,63) p = 0,001, given 1 vascular-bed disease as a reference group. Conclusion In post-ACS patients with OMT, PVD and atheroma burden represent powerful prognostic markers of CV events, while diabetes remains the only independent marker of CV events among traditional CV risk factors.

Objectif Apres un syndrome coronarien aigu (SCA), l'optimisation du traitement medical et des habitudes de vie a prouve son efficacite dans la reduction des evenements cardio-vasculaires (CV). Cependant, certains patients presentent un autre evenement CV malgre l'atteinte des cibles de prevention secondaire. Le but de l'etude est d'identifier les marqueurs predicteurs du risque residuel de patients post-SCA recevant une prise en charge optimisee, de presenter un evenement CV. Patients et methodes 990 patients avec un SCA ont beneficie d'une prise en charge intensive des facteurs de risque (FDR) CV et de la maladie atheromateuse, incluant l'optimisation des traitements et l'education therapeutique. Les FDR traditionnels et les marqueurs vasculaires (Epaisseur Intima Media (EIM), atherome carotidien, Index de Pression Systolique (IPS) et le nombre de coronaires avec une stenose > 50%) ont ete evalues 3 mois apres le SCA. Les evenements CV ont ete recueillis au suivi (Deces CV, SCA, AVC, Insuffisance cardiaque, revascularisation). Resultats Au decours d'un suivi median de 20 mois, plus de 80% des patients ont atteint les cibles de prevention secondaire. 116 evenements CV ont ete recueillis. Dans cette population, le diabete est le seul FDR qui reste associe au risque d'evenement CV en analyse multivariee (incluant âge, sexe, HTA, LDL cholesterol, tabac, diabete et CRPus) ; HR 1,61, p=0,017. En analyse multivariee incluant les FDRCV et les marqueurs vasculaires, seul l'IPS bas reste associe aux evenements CV ; HR 1,83, p=0,04. Le nombre de territoires arteriels atteints est associe au pronostic apres SCA : HR pour 3 territoires atteints 3,85, p=0,001, en comparaison avec l'atteinte d'un territoire. Conclusion Chez les patients en post-SCA ayant une prise en charge optimisee, l'arteriopathie des membres inferieurs et la charge en atherome sont des marqueurs puissants du risque CV. Le diabete reste le seul marqueur independant du risque CV parmi les FDR traditionnels.