BACKGROUND

Prognosis after acute coronary syndrome (ACS) depends on many factors, including not only somatic status and in-hospital treatment, but also the quality of subsequent outpatient follow-up.

OBJECTIVE

To assess the impact of outpatient follow-up on overall and cardiovascular mortality after acute coronary syndrome.

MATERIAL AND METHODS

The study included 1808 patients from one of the subjects of the Central Federal District (1164 (64.4%) men, 644 (35.6%) women) who were discharged after inpatient treatment for unstable angina or myocardial infarction in regional vascular center between January 1, 2019 and December 31, 2020. We analyzed overall and cardiovascular mortality depending on the form of outpatient follow-up, comorbidities and severity of coronary artery disease. The median period between discharge and registration for outpatient follow-up was 34 (17—79) days, follow-up period — 41.7±11.1 months.

RESULTS

Patients who were not followed-up (n=521) were older (66.62±12.9 vs. 62.98±11.5 years). Previous AF (19 vs. 12.4%) and CKD (16.9 vs. 8.3%) were more common compared to those who were under follow-up (n=1287). Outpatient follow-up by cardiologist was associated with 3.23 times (95% CI 2.46—4.25) lower risk of all-cause mortality, cardiologist at the cardiology dispensary — 3.07 times (95% CI 2.31—4.08), therapist — 1.5 times (95% CI 1.07—2.12) compared to the absence of follow-up by (p<0.001). For cardiovascular mortality, these values were 3.43 (95% CI 2.36—4.99), 3.72 (95% CI 2.52—5.45), and 2.03 (95% CI 1.28—3.23), respectively (p<0.001). Outpatient follow-up by cardiologist was associated with lower risk of all-cause and cardiovascular mortality after ACS with various coronary artery lesions regardless concomitant CKD/AF.

CONCLUSION

Outpatient follow-up is associated with better survival after ACS. Outpatient follow-up by cardiologist at the polyclinic or dispensary is associated with lower overall and cardiovascular mortality after ACS.